For ICD-10 F codes for “Mental Behavioral and Neurodevelopmental disorders,” please see the following page ICD-10 F codes: Mental, Behavioral, and Neurodevelopmental disorders.
There are also ICD-10 codes other than the F codes that are also useful to us as mental health professionals. These are discussed briefly on this page.
Other ICD-10 codes
Why would mental health clinicians need ICD-10 codes other than the F codes for mental disorders?
1. At least in the US, when mental health clinicians order laboratory tests, they have to provide ICD-10 diagnostic codes without which the insurance company will not pay for the laboratory tests. For some “basic” laboratory tests, the ICD-10 code for the mental disorder(s) the person has been diagnosed with is sufficient. But, for other laboratory tests, health insurances refuse to pay for the laboratory test because they don’t think that those laboratory tests are indicated for the mental disorder for which the diagnostic code was provided when the test was ordered. This can be a pain in the you-know-what, both for us (we get a letter asking us to provide additional diagnostic codes) and for the patient (who may receive a bill for the test). As discussed below, we have several other options for diagnostic codes to put down when ordering laboratory tests.
2. Also, since DSM-5 got rid of multiaxial diagnosis, by listing “non-psychiatric” diagnostic codes in the medical record, we can highlight these other conditions and provide a more holistic picture of the patient.
3. In determining which billing codes to submit to the patient’s health insurance company, one factor is the complexity of the case. Listing several or all of the diagnostic codes that apply is one way to show the complexity of the case.
Which ICD-10 codes can we put down?
1. Codes for the mental disorder being treated
2. Codes for therapeutic drug monitoring
3. Codes for the symptom or sign that prompted the testing, if any
4. Codes for a screening test in the absence of any particular symptom or sign
Tip: If more than one diagnostic code applies to a particular patient, it is wise to put all of them down to reduce the chances of the insurance not paying for the test. We are not limited to putting down only one diagnostic code when ordering the laboratory tests.
Next, let’s look at some such diagnostic codes that may be relevant to our clinical work.
E codes: “Endocrine, nutritional and metabolic diseases”
In ICD-10, diagnostic codes that start with the letter “E” cover “Endocrine, nutritional and metabolic diseases”. Some of our patients are known to have a deficiency or condition for which the codes below apply.
E 53.8 Deficiency of other specified B group vitamins
E 55.9 Vitamin D deficiency, unspecified
E61.1 Iron deficiency
E66.1 Drug-induced obesity (Reference)
E78.5 Hyperlipidemia, unspecified
Z codes: “Factors influencing health status and contact with health services”
What if we are checking a laboratory test for the first time and not because we know that the person has had an abnormality on that test? For example, we may be checking the RBC folate level in a person who has not had an abnormal level in the past.
Here’s another example: If a patient has sexual dysfunction and we want to check serum testosterone, if we use the code E29.1 (Testicular hypofunction), the insurance will probably pay for the test because the diagnosis code indicates that the patient HAS the deficiency, not that the test is being done to see IF the person has the deficiency. While this approach works in terms of getting the lab test paid for, strictly speaking, this is not the right thing to do. Instead, we should put a diagnostic code indicating that we are screening for possible health problems that may be present.
The following code(s) could be considered when we are ordering a laboratory test to check for something but don’t know that the patient has that problem:
Z13.21 Encounter for screening for nutritional disorder (Reference)
Z13.29 Screening for other suspected endocrine disorder (Reference)
Z51.81 Encounter for therapeutic drug level monitoring. We can use this code when measuring the serum level of a medication, e.g., serum lithium, serum carbamazepine, valproic acid level, and so on.
Z79.899 Other long-term (current) drug therapy. We can use this code if doing lab tests that should be done because the person is on a particular medication, e.g., TSH and Basic Metabolic Panel in a patient who is on lithium.
Z00.00 General adult medical examination without abnormal findings. This is a billable diagnosis code used when the person is getting health checked even without a specific complaint (Reference). This code can be used when screening for vitamin D deficiency. The problem is that the insurance companies consider screening for vitamin D deficiency ONLY in certain circumstances.
R codes: “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”
Another option: Instead of the ICD-10 code for the illness, we can put down the diagnosis code for the symptom or sign that prompted the testing. Here are some examples of such codes that mental health clinicians may use:
R41.82 Altered mental status
R53.83 Other fatigue (Reference)
And, from another chapter in ICD-10: E66.1 Drug-induced obesity (Reference)
Related Pages
What laboratory tests should a mental health clinician order and when?
Clinicians’ guide to screening tests in mental health
The 12 Sins in Laboratory Testing in Mental Health
References
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