August 17, 2009

Coding for Depression
For The Record
Vol. 21 No. 16 P. 28

Depression is a medical illness that involves both the mind and body, affecting how a person thinks and behaves. It can also cause a variety of emotional and physical problems. A person who is depressed may not be able to perform daily activities or may have suicidal thoughts. Some people may experience only one episode of depression, but most people have repeated episodes of symptoms throughout their lives.

Depression is assigned to ICD-9-CM code 311. This also includes documentation of depressive disorder and depressive state, not otherwise specified. If the depression is specified or due to other specified causes, the code assignment may change.

Symptoms
Common symptoms of depression include loss of interest in normal daily activities, sadness, hopelessness, crying for no apparent reason, sleeping problems, trouble with focusing or concentrating, difficulty with making decisions, unintentional weight gain or loss, irritability, restlessness, easily becoming annoyed, fatigue or weakness, feeling worthless, loss of interest in sex, suicidal thoughts, and unexplained aches and pains.

Although there is no precise cause of depression, the following are triggers or risk factors of depression: biological relatives with depression; family members who have committed suicide; stressful life events; depressed mood as a child; presence of a chronic illness; long-term use of certain medications; low self-esteem, overly dependent personality, self-critical, or pessimistic; alcohol, nicotine, and/or drug abuse; a recent child birth; and lower socioeconomic level.

Diagnosis
To assist with diagnosing depression, the physician may have the patient complete a questionnaire to screen for depression symptoms, perform a physical exam, order blood tests such as complete blood count and thyroid function, or perform a psychological evaluation, asking about the patient’s thoughts, feelings, and behavioral patterns.

These tests can help rule out other conditions that could cause symptoms similar to depression and could also pinpoint the accurate diagnosis and find any related complications.

Other possible conditions that could resemble depression include the following:

• Adjustment disorder (category 309): a severe emotional reaction to a difficult event.

• Bipolar disorder (category 296): characterized by mood swings that range from highs to lows.

• Cyclothymia (301.13): a mild form of bipolar disorder.

• Dysthymia (300.4): a less severe but more chronic type of depression.

• Postpartum depression (648.4x): a type of depression found in new mothers usually within a month of giving birth. The fifth-digit subclassification depends on the episode of care.

• Psychotic depression (category 296): a severe type of depression with delusions or hallucinations.

• Schizoaffective disorder (295.7x): This condition meets the criteria for both schizophrenia and a mood disorder. The fifth-digit subclassification identifies the acuity of the condition.

Treatment
Treatment for depression may include one or a combination of the following: medication, psychotherapy, electroconvulsive therapy, or brain stimulation.
The following are some of the common antidepressant medications given to patients diagnosed with depression:

• selective serotonin reuptake inhibitors such as fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro);

• serotonin and norepinephrine reuptake inhibitors;

• norepinephrine and dopamine reuptake inhibitors;

• combined reuptake inhibitors and receptor blockers;

• tetracyclic antidepressants;

• tricyclic antidepressants; and

• monoamine oxidase inhibitors.

Coding and sequencing for depression are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.