Wiki Icd-9 coding depression and bipolar same dos

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clebius

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Hello,
I need some feedback. I was QA'ED on a chart where the patient had a diagnosis of depression and bipolar in the PMH and there was medication support. I was told that depression and bipolar cannot be coded together because depression is part of bipolar.
I am a nurse and know that these 2 disorders are different even though a bipolar patient can have depression. I questioned this and said I have never been told that nor is it documented in the icd guidelines or our company guidelines.

What is the correct answer? Can they be coded together when they have been diagnosied and have MEAT support??

All answers will be graciously welcomed. I am a nurse turned coder and do not claim to be a coding wizz
thanks,
connie
 
Per our ICD 10 book, Mood disorder can be broken down into bipolar and major depression. There is no exclusion note saying that they cannot be coded together. I have seen medical records where both have been coded simultaneously. I am not sure about the clinical part of this. Hope this helps.
 
clebius said:
Hello,
I need some feedback. I was QA'ED on a chart where the patient had a diagnosis of depression and bipolar in the PMH and there was medication support. I was told that depression and bipolar cannot be coded together because depression is part of bipolar.
I am a nurse and know that these 2 disorders are different even though a bipolar patient can have depression. I questioned this and said I have never been told that nor is it documented in the icd guidelines or our company guidelines.

What is the correct answer? Can they be coded together when they have been diagnosied and have MEAT support??

All answers will be graciously welcomed. I am a nurse turned coder and do not claim to be a coding wizz
thanks,
connie
Click to expand...

Stating that "depression is a part of bipolar" is true, but it probably should have been worded as "depression (or depressive) episodes are a part of bipolar."

With bipolar disorder, a patient has episodes of mania or manic behavior as well as depressive episodes. These phases are typically sporadic and intermittent so there could be huge gaps of time where the patient is neither depressed nor manic. It's also noteworthy to mention that the episodes of mania are extremely high and depressive episodes are extremely low in intensity. There's actually different types of bipolar disorder; for example, bipolar I is when the person experiences severe mania to the extent they may require hospitalization. Bipolar II is when a person has the manic episodes, but not as extreme as with bipolar I.

With depression or major depressive disorder, it's an ongoing, everyday, 24-7 condition. There may be "better" days and "worse" days, but it's all still depression. There are no extreme highs as with bipolar. It would be very, very rare for a person to have both disorders because of this fact. If a person diagnosed with depression experiences a manic episode, that'd be where the shift to a bipolar diagnosis would occur.

I think the hang up is separating "depression" and "depressive episodes". The chart listing both would prompt me to query the provider about the depression diagnosis. As I mentioned above, it may be a case in which the patient has made a shift from depression to bipolar, in which coding both would be incorrect as the transition to bipolar occurred. It may also be the case that the provider intended to document the patient being in a depressive episode of the bipolar disorder. Needless to say, the criteria for depression doesn't include manic episodes; that'd be bipolar.
 
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