Wiki Should you code F25.0 and F31.9 together in the same encounter?

[westcoastjen]

A provider indicates in the A/P that the patient has been diagnosed with both schizoaffective disorder bipolar type as well as bipolar unspecified. Should you capture both codes, or only F25.0? F25.0 belongs to HCC 57, and implies that the bipolar is already included in the code. F31.9 belongs to HCC 59, and if it is included in code F25.0 then it seems to be redundant to code it in addition to F25.0. Can someone please shed some light on this for me? Thank you!

 

[GReneau]

Hi Jen,

As long as the diagnosis pointer indicates F25.0 as the primary diagnosis, there shouldn't be an issue. As you said, it is redundant, but shouldn't cause any problems. The only thing I can foresee is that by using both ICD-10 codes, it can look as though the MDM is being artificially inflated. I would suggest maybe using just F25.0 and manually adding a specifier to indicate the patient's current or most recent episode (manic or depressed). Prior to DSM-5, schizoaffective was actually a specified type of bipolar disorder, so the diagnosis would have been Bipolar Disorder, schizoaffective type. I don't think either version does a very good job of summing up the nature or variations associated with the diagnosis. Alternately, the F31.9 could have been used to indicate that the patient has other mood fluctuations that might not be associated with their schizoaffective disorder (i.e., SAD, shift-work disorder, etc.). It's a reach, but I've seen it done. It may help to go back and review the documentation to see if you can track down which diagnosis came first and/or if some justification can be found for the additional diagnosis.

Good luck!
Ginny

 

[westcoastjen]

Thank you, Ginny! That is really helpful!