The official coding and documentation requirements for the ICD-10 and DSM-5 are both detailed and at the same time, “loose.” Thankfully, this dialectic leaves the clinician room to utilize their fine-tuned judgement skills. From an auditors perspective however, it is best to know the “details” of the coding rules to substantiate your documentation processes and diagnostics. While the rules vary throughout both manuals, the one area that is fairly consistent in coding guidelines is in the area of chronic illnesses that contribute to mental conditions.
Think about the consumers you see on a daily basis with Serious Mental Illness: how many of them are also coping with chronic health conditions such as diabetes and hyperthyroidism? The interplay between their physical health and mental health status is a “chicken-and-egg” situation that does not facilitate the goals of the Triple Aim. This is exactly why we need coordinated, truly integrated care models if our population is to become healthier. Having a Continuity of Care Document (CCD) that lists all applicable diagnoses that affect a consumers condition will help facilitate holistic, and comprehensive, treatment.
Fortunately, the ICD-10 and DSM-5 takes this holistic approach into account when they direct us to document applicable co-existing medical conditions. For example, if you diagnose F06.3x (BiPolar and Related Disorder Due To Another Medical Condition), we are to ”code first” the medical condition that contributes to this specific BiPolar diagnosis. If the condition is due to Hyperthyroidism, then the first code we list is: E05.90: Hyperthyroidism.
The coding rules vary for the different diagnostic categories, and sometimes even within the categories. This will pose workflow, operational and procedural changes for provider organizations, their clinicians, and revenue cycle staff. Most importantly, organizational cultural norms (and their deeply embedded clinical documentation habits that are very difficult to change) will be challenged by the transition to ICD-10. Flipping the clinical documentation switch on October 1, 2015 will not be effective without forethought, considerable training and planning. It will require education and lots of practice for months ahead of the scheduled change. Your IT vendors can take you only so far in the process. The rest is up to the provider organization.