Transitioning to ICD-10
Behavioral Health
Jeri Leong, R.N., CPC, CPC-H, CPMA
Healthcare Coding Consultants of Hawaii LLC
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Course Objectives
•Review of new requirements to ICD-10-CM
•Identify the areas of similarities and
differences between ICD-9-CM and ICD-10-CM
•Understand the relationship between DSM-5
and ICD-10-CM
•Prepare for your transition by learning how to
crosswalk ICD-9 to ICD-10
•Determine clinical documentation elements
required for ICD-10 code assignment 
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ICD Background
Information
•Published by WHO in 1990
•U.S. last industrialized nation to
implement ICD-10
•Two parts: ICD-10-CM and ICD-10-PCS
•ICD-10-CM - Diagnosis
•3–7 alpha/numeric characters
•ICD-10-PCS – Inpatient Procedures
•7 alpha/numeric characters
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DSM-5 and ICD-10-CM
• ICD codes are used for billing purposes; they support CPT
codes that describe various services
• DSM has been the industry standard for behavioral health
however the codes are not acceptable for billing purposes
• DSM IV and ICD-9-CM closely paralleled each other and
were simple to convert for billing purposes
• DSM-IV and/or DSM-V codes must be converted to ICD10-CM codes for claim submission
• DSM-V contains the information needed to assign HIPAAcompliant, valid ICD-10-CM codes for a psychiatric
diagnosis
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• The increased specificity of ICD-10-CM will
not always provide for an effective crosswalk
from DSM-5 criteria
• For example, Schizoaffective Disorder (ICD-9
295.70) now splits into two ICD-10 codes
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ICD-10 Format
•Codes are alpha numeric
•All letters of the alphabet except U
•“V” codes are now Z codes
•“E” codes are now V,W,X,Y codes
•Second through seventh characters are a
combination of letters and numbers
•Remember “I” is not a “1”
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ICD-10-CM vs. ICD-9 Code
Structure
ICD-10-CM Code Format
ICD-9-CM Code Format
Ex: Bipolar disorder, current episode manic without
psychotic features, mild
ICD-10: F31.11
ICD-9: 296.41
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Placeholders
•ICD-10 utilizes a placeholder “X”
•The “X” is used as a fourth, fifth or sixth
character placeholder to allow for future
expansion
•7th character extender is used to
designate episode of care
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th
7
Character Extenders
•Identifies episode of care for injuries
•Initial - Receiving active treatment
•Subsequent - Receiving routine care
during healing or recovery (after active
treatment)
•Sequela - Complications or conditions
arising as result of a condition
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Example – Placeholder and
7th Character Extender
Poisoning by, adverse effect of, and
underdosing of other psychotropic drugs
(intentional self-harm), initial encounter
T43.8X2A
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Mental, Behavioral and
Neurodevelopmental Disorders
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Mental Disorders due to
Physiologic Conditions
• F01 Vascular Dementia
• F01.50 without behavioral disturbance
• F01.51 with behavioral disturbance
• F02 Dementia in other diseases classified elsewhere
• Code first the underlying physiologic condition, such as*:
• Alzheimers (G30.-)
• HIV disease (B20)
• Neurosyphilis (A52.17)
• F06 Mood disorders
• Further classified as those with various features, such as
depressive or manic
*not an all-inclusive list
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Substance Abuse and
Dependence
• F10 – F19 Unique codes for alcohol and drug use,
abuse, and dependence
• Continuous or episodic no longer classified
• Combination codes describe dependence, with
manifestations such as delirium, hallucinations,
dementia
• Codes are similar to ICD-9 in that they identify abuse,
dependence and use
• Alcohol and various drugs are listed by category
• Blood alcohol level is listed as an additional code, if
known (Y90.-)
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Remission
•Selection of codes for “in remission” - categories
F10-F19 requires the provider’s clinical judgment
•The appropriate codes for “in remission” are
assigned only on the basis of provider
documentation 
•ICD-10-CM does not provide separate "history"
codes for alcohol and drug abuse. These
conditions are identified as “in remission” in
ICD-10-CM
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Nicotine Dependence
ICD-9-CM = 305.1
• Tobacco Use Disorder
-Current smoker
Additional
documentation
required
ICD-10-CM = F17-
• Terminology change to
Nicotine dependence
• Type of nicotine (cigarette,
chewing tobacco, cigar, pipe,
etc.)
• Remission/Withdrawal/
Uncomplicated
• Use Z87.891 for History of
nicotine dependence
• Use Z72.0 Tobacco Use (nondependent)
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Schizophrenia, Schizotypal,
Delusional and Other Nonmood Disorders
•F20 – F25 represent various disorders
•Schizophrenia is further categorized by type,
such as paranoid, disorganized, catatonic,
undifferentiated and residual
•Psychotic disorders F23 and F24
•Schizoaffective disorders fall into F25 and are
further broken down into bipolar type and
depressive type
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Mood (affective) Disorders
• F30 represents the category for manic disorders
• In order to accurately assign an ICD-10 code,
additional documentation will be required: 
• with or without psychotic symptoms
• severity of illness (mild, moderate, severe)
• status of illness (partial or full remission)
• F31 represents bipolar disorders
• Additional documentation is required 
• with or without psychotic features
• severity of current episode (mild, moderate, severe)
• status of episode (partial or full remission)
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Mood Disorders - continued
• Major depressive disorders F32.- and F33.• Includes various types including endogenous,
psychogenic, reactive, seasonal and others
• Similar to ICD-9, depressive disorders are
categorized based on
• Episode (single or recurrent)
• Severity (mild, moderate severe)
• With and without psychotic features
• Status of illness (partial or full remission)
• Cyclothymic disorder F34.0
• Dysthymic disorder F34.1
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Anxiety, Dissociative, Stress-related,
Somatoform and Other Nonpsychotic
Disorders
• Phobic anxiety disorders F40.• Additional documentation required for specific types
of phobias, including animal type, natural
environment, medical care, situational and ‘other’
• Agoraphobia is further categorized as with or
without panic disorder
• Anxiety disorders are coded similarly to ICD-9, specific
to generalized or mixed
• Post-traumatic stress disorder is subcategorized as
• F43.10 Unspecified
• F43.11 Acute
• F43.12 Chronic
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Behavioral Syndromes Associated with
Physiological Disturbances and
Physical Factors
• Anorexia nervosa is split into three sub-categories and
documentation must support the type for proper ICD-10
assignment 
• F50.00 Unspecified
• F50.01 Restricting type
• F50.02 Binge eating/purging type
• Bulimia and other eating disorders (F50.2-F50.9)remain basically
the same from the perspective of ICD assignment
• Sleep disorders (F51.-)require additional documentation elements
to specify the type of insomnia 
• Primary
• Adjustment
• Paradoxical
• Due to other mental disorder
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Disorders of Adult Personality and
Behavior
• Specific personality disorders are described in this
section (F60.-) including
• Paranoid personality disorder F60.0
• Schizoid personality disorder F60.1
• Antisocial personality disorder F60.2
• Borderline personality disorder F60.3
• Histrionic personality disorder F60.4
• Obsessive-compulsive personality disorder F60.5
• Avoidant personality disorder F60.6
• Dependent personality disorder F60.7
• Narcissistic personality disorder F60.81
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Behavioral and Emotional Disorders
with Onset Usually Occurring in
Childhood or Adolescence
• Attention deficit hyperactivity disorders are categorized
as:
• Predominantly inattentive type F90.0
• Predominantly hyperactive type F90.1
• Combined type F90.2
• Conduct disorders are categorized as
• Confined to family context F91.0
• Childhood onset type F91.1
• Adolescent onset type F91.2
• Oppositional defiant type F91.3
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Other Behavioral and Emotional
Disorders with Onset Occurring in
Childhood and Adolescence
•This category (F98.-) include various disorders
such as
•Enuresis F98.0
•Encopresis F98.1
•Feeding disorders F98.2•Movement disorders F98.4
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Tools For Success
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DSM and ICD-10
•Determine how DSM-5/ICD-10 will impact your
practice
• Review pre-authorizations, physician orders, billing
software and other workflow tasks to ensure the
seamless flow between DSM-4 and DSM-5 for
clinical data capture
• DSM criteria will likely still be needed for pre-auth’s
and data reporting
• Review how DSM-5/ICD-10 will affect clinical
documentation requirements and EHR templates
• For example, is the template still appropriate without
the 5 axis paradigm
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GEMs Translation
What is GEMs? General Equivalence Mapping
• A mapping tool that attempts to include all valid
relationships between the codes in ICD-9-CM and ICD10-CM
• An excellent training tool to be used to familiarize
differences between ICD 9 and ICD-10 and may also be
used to select the correct ICD-10 code.
• The mapping identifies one-to-one and one-to-many
code relationships
• Only 5% of ICD-9 to ICD-10 are a direct match
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In Summary
•DSM is clinical; ICD is for billing
•Many ICD-10 codes mirror ICD-9 in context,
however there is expanded granularity for some
categories
•Alcohol and substance dependence, abuse and
use are more specific to the substance involved
•Clinical documentation is key for assignment of
accurate ICD-10 codes
•If using EHR for lookups, utilize multiple words to
narrow the search process
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Questions?
ICD10@hmsa.com
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