Success Codes The Next Generation—Psychosis

The 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions.



We talked before that, though these changes are not revolutionary, they will give you the chance to gain some additional risk-based revenue.



We also discussed how important it is to start coding these conditions now, even though the changes are going to be phased in over three years starting in 2019. Experience teaches that getting ahead of the curve is the key to outsized performance.



I simplified what you needed to know about risk-coding mental health conditions in this earlier blog post.



Everything there is still accurate—and it’s still great.



But starting in 2019, conditions that previously were not associated with increased revenue will now get you additional credit.



Although lots of details still need to come out, here is what you, as a clinician or the supervisor of clinicians, need to know.





Currently, only specific diseases with psychosis as one of their characteristics are associated with increased revenue. Examples include Schizophrenia and Bipolar disorder.


Starting in 2019, two new categories of diagnoses will be included other Psychoses and Personality Disorders will also be included.


For the purposes of risk coding you have to remember the DSM-V definition of psychosis we all had to memorize during our third-year Psych rotation—” an abnormal difficulty of the mind wherein there is a difficulty in distinguishing reality.”


Remember that.


Consider the psychotic demented patient in the nursing home, the otherwise healthy patient sundowning as an inpatient, the walk-in with the undiagnosed thought disorder.


Prior to 2019, none of these patients would have any diagnosis that would have counted as a risk-code.


That’s about to change.


From 2019 onward, for the most part, it won’t really matter what’s causing the psychosis, only that the psychosis itself exists.


If you can document that, you should be able to code it correctly—just make sure the word “psychosis” is in the diagnosis descriptor and you should be fine.


But if the psychosis is present and you’re not sure what’s causing it, you only need to remember one code.


F29—psychosis, unspecified not due to a substance or known physiologic condition.


That’s your fail-safe.


Keep that in your back pocket and use it at need.


And you will succeed—wildly.







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