DSM5 to ICD-10 codes: how do you Defer/No Diag or include medical illness codes?

[Groupthink]

As you probably know, on October 1st we all had to switch to using ICD-10 codes for billing purposes.

It appears that the ICD-10 equivalents to 799.9 Diagnosis Deferred and V71.09 No Diagnosis are R69 and Z71.1, respectfully.

Is this accurate?

In addition, if a client carries a medical diagnosis related to treatment (e.g., hyperthyroidism) how am I supposed to go about finding the ICD-10 code for their specific diagnosis to include? (without having to get a release for data from their medical provider) I was thinking we could use the "R" codes from ICD-10 since those are symptom codes rather than diagnostic codes, but I am not sure.

Thank you in advance for your responses.

Edit: Today I learned that there is also a Z03.89 for "No Diagnosis". The difference is that Z71.1 implies that the clinician has chosen not to make a diagnosis based on info that is available, whereas Z03.89 states that all suspected conditions have been ruled out. An important nuance that does little to clarify which I should be using!

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[President_LeslieKnope]

This doesn't speak to your question, but a fellow intern sent this to me and I think it answers a lot of burning ICD-10 questions we have ;-)

http://www.healthcaredive.com/news/the-16-most-absurd-icd-10-codes/285737/

 

[smalltownpsych]

I am not sure what you are asking. Why would you use no dx since we don't use multixaxial anymore? I just code the disorders that I am diagnosing or treating. I don't diagnose purely medical issues but will list them if they are relevant and I state where that info come from whether it's dr. So and so or per patient report. Then I include any relevant psychosocial stressors and no GAF score anymore. With DSM-IV, I would mostly use the 799 for Axis 2, but we don't have that anymore which is actually a good thing IMO

 

[Groupthink]

My training director just sent

I am not sure what you are asking. Why would you use no dx since we don't use multixaxial anymore? I just code the disorders that I am diagnosing or treating. I don't diagnose purely medical issues but will list them if they are relevant and I state where that info come from whether it's dr. So and so or per patient report. Then I include any relevant psychosocial stressors and no GAF score anymore. With DSM-IV, I would mostly use the 799 for Axis 2, but we don't have that anymore which is actually a good thing IMO

I work in college mental health. Our paperwork and ticketing system requires that we fill in a diagnosis. Occasionally we will have a triage where the concern is not mental health related and no diagnosis is warranted, but a write-up with a diagnostic code is required for paperwork.

 

[smalltownpsych]

Our computer system lists no diagnosis for mental health issues as Z03.89. I don't know where the coders got that information. Looking at the DSM-5 there is some helpful information at the back of the book with codes for many non-diagnoses. Z71.9 would be code for other counseling or consultation. Also, why would they have you code the medical condition? I wouldn't want to because that implies that I diagnosed it.

Another good one I saw was Z65.9 Unspecified problem related to unspecified psychosocial circumstance. I would read that as, "I have no idea what is going on with the patient or why it's even happening, but it seems to be some type of problem."

 

[AcronymAllergy]

I could be wrong, but I believe you can bill the initial appointment based on the reason for referral/presenting problem. So if someone's being referred in neuropsych to assess for Alzheimer's, for example, I think you can technically bill using the Alzheimer's code, even if that's not ultimately the diagnosis. Or in a college clinic, if someone's being referred for an intake to determine if they're depressed and need treatment, possibly bill unspecified depressive or adjustment disorder.

And you likely already know, but everything in DSM-5 is in ICD-10; that's what the F codes are for.