Pediatric Coding Alert

Question: Our pediatrician diagnosed a teenage patient with bipolar disorder and major depressive disorder. Is this an instance where I’d code both disorders or just one?

North Carolina Subscriber

Answer: Bipolar disorder includes mania, so there are clearly clinical differences between bipolar disorder and major depressive disorder. In this instance though, you would only report bipolar disorder. Here’s why.

First, take a look at the notes written alongside the bipolar and major depressive episode codes. F32.- (Major depressive disorder, single episode) and F33.- (Major depressive disorder, recurrent) codes are Excludes1 codes for the F31.- (bipolar disorder) codes, and the F31.- codes are Excludes1 codes for the F32.- and F33.- codes. This means whenever presented with a bipolar disorder diagnosis, you’re not to code also major depressive disorder and vice versa.

Reinforcement of these instructions appears in the AHA 1CD-10-CM Coding Clinic explanation: “… it is more important to capture the bipolar disorder… a code for depression would not be reported separately” (Coding Clinic 2020, Vol 7, No.1).

Coding to the highest specificity might require you comb through the notes again or query the provider. That’s because the codes within the F31.- category are divided into subcategories defined by additional details of the patient’s experience with the condition. For example, if the patient is currently experiencing bipolar episodes, you’d select from F31.0-F31.6. If the patient’s condition is in remission, you’d select from the F31.7- codes. Other forms of the condition are coded using the F31.9- codes, as well F31.9 (Bipolar disorder, unspecified). ICD-10 breaks these subcategories up further to account for severity and symptoms such as hypomanic, psychotic features, depression, and a mix.

If your pediatrician has included such details, be sure to select the most specific code. If not, a query is necessary.