Mental health coding in the primary setting can be incredibly problematic for both the provider and the coding team. Using questionnaires such as the PHQ-9 can give insight to the level and severity of mental health status of the patient. Appropriately documenting and specific coding of these ailments will show the true needs of the patient – whether it be medications, additional behavioral health appointments, community resources & support.
“DSM-5’s diagnostic criteria identifies five or more symptoms present during the same 2-week period and represents a change from previous functioning and must include at least depressed mood most of the day, nearly every day or loss of interest or pleasure of all or almost all activities most of the day, nearly every day.” However, grief is different in that “…distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief, the predominate affect is feelings of emptiness and loss, while in MDE, it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensive over days to week and occurs in waves, the so-called pangs of grief.”
Coding grief, mood disorders, anxiety and depression all have different ICD-10 codes and different risk values depending on the payer. Medicare and Medicare Advantage plans only recognize specific codes for depression under its HCC model. It is important to also record any drug or alcohol related issues too in the chart which not only affect treatment but can increase the risk score which will affect reimbursement. Remember that reimbursement for risk coding is very different than CPT/procedural coding in that it is based on the expected expenditures of your patient.
With all this being said, it is understood that it may take multiple appointments, including those with behavioral health, to establish the correct diagnosis. We are simply encouraging you to make a specific diagnosis as soon as it is reasonable to do so.
Source: https://libmaneducation.com/hccs-and-coding-of-major-depressive-disorder/
