Psychiatry Coding & Reimbursement Alert

Bonus: More choices for other anxiety-related conditions improve your accuracy.

As a psychiatry coder, you frequently encounter patients suffering from generalized anxiety disorder. Reporting this condition accurately when the new ICD-10 codes come into effect will depend on specifics on anxiety type and noting the associated signs and symptoms. Get a head start on assigning the appropriate anxiety code -- and keeping your reimbursement flowing -- with the following advice.

Review Anxiety Services Reporting Options

Typically, your physician will arrive at a diagnosis of generalized anxiety disorder based on a complete history and an evaluation of the person's signs and symptoms. You may report CPT® code 90801 (Psychiatric diagnostic interview examination) to capture the psychiatric diagnostic/evaluative interview services.

This service would include a complete mental status examination, a complete psychiatric and medical history of the patient and family, a review of systems, and ordering and interpreting diagnostic tests. The physician will assess the patient for other conditions, such as depression and other anxiety disorders, such as anxiety states due to substance or drug abuse and sexual dysfunction.

Based on location, time spent with patient, nature of the psychotherapy, and whether or not medical evaluation and management services were also provided, you may report subsequent psychotherapy with other codes. For example, if the psychiatrist provides insight oriented, behavior modifying, or supportive psychotherapy, you would report a code from 90804-90809 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility...) if the patient is seen in your physician's office. You will report similar psychotherapy with 90816-90822 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting...) if the psychotherapy is provided in a hospital setting.

Switch From 300.02 to F41.1

Currently, you'll report generalized anxiety disorder with ICD-9 code 300.02 (Generalized anxiety disorder).

When ICD-10 codes come into effect, you will use F41.1 (Generalized anxiety disorder). Note that the descriptor to generalized anxiety disorder under ICD-10 is the same as it was in ICD-9.

Under F41.1, you can also report other anxiety-related conditions such as anxiety neurosis, anxiety reaction, anxiety state, and overanxious disorder. However, you cannot use this code if your physician arrives at a diagnosis of neurasthenia (F48.8, Other specified nonpsychotic mental disorders).

If the patient suffers from other anxiety disorders along with generalized anxiety disorder, your physician might arrive at a diagnosis of mixed anxiety disorders. In ICD-9, you report a diagnosis of mixed anxiety disorders using 300.09 (Anxiety states; Other).With ICD-10, you would use F41.3 (Other mixed anxiety disorders).

More ICD-10 options: When reporting diagnoses for the most common signs and symptoms of generalized anxiety disorder, you may use these ICD-10 codes: trouble sleeping (G47.9, Sleep disorder, unspecified, or Z72.82, Problems related to sleep), palpitations (R00.2, Palpitations), clammy extremities (R23.1, Other skin changes; Pallor), dryness of the mouth (R68.2, Dry mouth, unspecified), nausea (R11.0, Nausea), dizziness (R42, Dizziness and giddiness), and tingling (R20.2, Disturbances of skin sensation; Paresthesia) or numbness (R20.0, Disturbances of skin sensation; Anesthesia).

Coding example: A 45-year-old male patient arrives at your psychiatrist's office. He complains of excessive worrying about the safety of his family, fear of losing his job, and apprehensions about simple day-to-day decision making. Your psychiatrist documents in the patient's notes that the patient has been suffering from this type of fear and apprehension for a long time, and it is affecting the patient's work and family life.

Based on a thorough evaluation, your psychiatrist arrives at a diagnosis of generalized anxiety disorder. Your psychiatrist then decides to provide cognitive behavioral therapy. The session lasts for 75 minutes.

Under ICD-10, you code the diagnosis with F41.1 and the therapy with 90809 (Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services).