Balance Out Uncertainty in Bipolar Disorder Dx
Knowing the four types and code categories will help you avoid inconsistent diagnosis coding.
By Mary Massey, CPC, AAPC Fellow
Bipolar disorder is a mental illness that produces “manic” and “depressive” cycles, which can be mild or severe. Individuals diagnosed with this illness often abuse drugs (both illegal and prescription), as well as alcohol, to control symptoms.
It’s a Roller Coaster of Emotions
Symptoms of the manic side of bipolar disorder include extreme energy, euphoria, heightened sexuality (promiscuity), major irritability, enhanced concentration, or lack of concentration. Some of these symptoms can be beneficial: The extreme energy and enhanced concentration, if channeled properly, can be useful.
Symptoms for the depressive side of bipolar disorder include feelings of helplessness, hopelessness, excessive eating (or not eating at all), low self-esteem, or lack of concentration. Suicidal tendencies and thoughts of hurting oneself, or others, are common. Extreme mood swings, from manic to depression, can happen in a moment.
Bipolar disorder can cause conflicts with family, friends, jobs, and life in general. Family education is required to positively affect a patient’s stabilization with the illness. Until educated about this illness, many people do not understand why a person with bipolar disorder acts as they do. Alienating the individual worsens the symptoms and lowers their self-esteem.
Bipolar disorder does not discriminate between men and women. The starting age for diagnosis is between 15 and 25 years old. There is no known cause for the disorder, but it is believed to run in families. Life events such as childbirth or death of a loved one, periods of sleeplessness, and recreational drug use have been known to trigger episodes.
Four Types of Bipolar Disorder
According to the National Institute of Mental Health, there are four types of bipolar disorder:
Bipolar I Disorder is mainly defined by manic or mixed episodes lasting at least seven days, or by manic symptoms so severe the person needs immediate hospital care. Usually the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms to be diagnosed with bipolar I or II; however, the symptoms are clearly out of the person’s normal range of behavior.
Cyclothymic Disorder or Cyclothymia is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. The symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
There is no blood test or physical finding to diagnose a patient’s bipolar condition. Psychologic tests, such as mood disorder questionnaires, can assist with a patient’s diagnosis and level of severity. An actual diagnosis can be obtained only through an in-depth discussion with a provider about the mood swings and activities resulting from those mood swings. Providers must take great care when documenting the specific circumstances of the patient’s condition to ensure valid coding.
In ICD-10-CM, bipolar disorder is coded from category F31. For patients who exhibit symptoms of bipolar disorder manic with or without psychotic episodes, report:
F31.1 Bipolar disorder, current episode manic without psychotic features
F31.2 Bipolar disorder, current episode manic severe with psychotic features
For patients who exhibit bipolar disorder depressive with or without psychotic episodes, report:
F31.3 Bipolar disorder, current episode depressed, mild or moderate severity
F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features
Other ICD-10-CM codes specific to bipolar disorder include:
F31.6 Bipolar disorder, current episode mixed
F31.7 Bipolar disorder, currently in remission
F31.8 Other bipolar disorders
F31.9 Bipolar disorder, unspecified
Codes for persistent mood disorders, such as cyclomythic disorder, are located in category F34 Persistent mood [affective] disorders; single manic episode codes are in category F30 Manic episode; and single depressive episode codes are in category F32 Major depressive disorder, single episode.
Treatments and Management
Bipolar disorder can be controlled with medication and psychiatric/psychological counseling/treatment. Finding the correct medication and dosage to manage the symptoms can be daunting, however, as the process is one of trial and error, and what works one day may not work the next. When a viable medication and dosage are found, the patient must take those medications responsibly. Many people suffering from bipolar disorder quit taking their medication when they feel better, only to experience a new, heightened episode
Bipolar disorder is a serious ailment. It’s difficult to live with, and the patient often has many medications they have to take to keep the illness under control. People with bipolar disorder may lead normal and productive lives if they stay on their medication, and receive counseling and medication checks on a regular basis.
A.D.A.M. Medical Encyclopedia. Atlanta, Ga.: A.D.A.M. 2011. Bipolar disorder. Manic
depression; Bipolar affective disorder:www.ncbi.nlm.nih.gov/pubmedhealth/
National Institute of Mental Health. U.S. Department of Health and Human Services. (2009).
Bipolar Disorder: www.nimh.nih.gov/health
Smith M., Robinson L., & Segal J. (2012). Bipolar medication guide: Medications and drugs for
bipolar disorder treatment: www.helpguide.org/mental/bipolar_disorder_medications.htm
Mary Massey, CPC, AAPC Fellow, graduated in 2012 from MedTech College with an associate degree in Medical Billing and Coding. She also has a bachelor’s degree in Management of Human Resources and a master’s degree in Management, both from Oakland City University. Massey is a member of the Greenwood, Ind., local chapter.