Pediatric Coding Alert

Question: A mother came in with her daughter concerned that she was spending too much time online using social media sites. The mother explained that the daughter was no longer interested in anything other than being online — she had been frequently skipping school, where her grades had plummeted, she spent every weekend alone in her bedroom on her computer, and she was getting angry and depressed over her online interactions and her mother’s attempts to limit her time on the Internet.

Our pediatrician referred the patient out suspecting she had Internet addiction, though he did not provide a definitive diagnosis. However, are there any ICD-10 codes I could have used to document the encounter, especially when I cannot find a code that even comes close to describing the disorder?

California Subscriber

Answer: According to a recent article in the Journal of Pediatrics, Internet addiction can be defined as preoccupation with the use of the Internet, repetitive thoughts about limiting and controlling the use of the Internet, failure to control the desire of access to the Internet, continuous use of the Internet despite the impairments at various levels of functionality, spending gradually increasing periods of time on the Internet, seeking use of the Internet in the case of inability to access, and uncontrolled desire to get access to the Internet” (Source:  www.jpeds.com/article/S0022-3476(17)31308-2/fulltext).

The disorder has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, it is included in the Emerging Measures and Models section, meaning that it has not yet been fully classified and needs further study before it can be an official diagnosis.

ICD-10 is even further behind DSM-5, having only added diagnoses for intimidation through social media as a condition that can be reported under the T74.3 (Psychological abuse, confirmed) and T76.3 (Psychological abuse, suspected) categories in its 2019 addenda. Consequently, as you have already said, you will not find an ICD-10 code to correspond with the diagnosis, and we may have to wait for ICD-11 before getting one.

In the meantime, there are some ICD-10 codes that might be appropriate in such encounters. Confer with your pediatrician and payer and see if they might be agreeable to using the following:

• F63.89 (Other impulse disorders)
• F63.9 (Impulse disorder, unspecified)
• F91.8 (Other conduct disorders)
• F91.9 (Conduct disorder, unspecified).

Additionally, you might find that Z60.8 (Other problems related to social environment) would be an acceptable encounter code to use in documenting the reason for the patient visit. As the F codes will be considered mental health, the Z code may be better for the patient regarding insurance coverage.