EmailSituational crisis
Publication Date: September 2016
ICD 10 AM Edition: Ninth edition
Retired Date: 30/6/2020
Query Number: 3065
Can you please clarify the application of ACCD Coding Rule published in March 2014 titled Situational Crisis. The query says
Where 'situational crisis' is documented, coders should look for documentation within the clinical record or seek clarification from the treating clinician to determine if the patient has a condition classifiable to Chapter 5 Mental and behavioural disorders (F00-F99) for example, an acute stress reaction or an adjustment disorder.
If documentation or clinical advice clarifies that the patient has a mental or behavioural disorder, assign an appropriate code from F00-F99.
Does there have to be a direct link/relationship between the patient's situational crisis and the patient's chapter 5 mental & behavioral disorder?
For example
1. Patient admitted for situational crisis with past history of depression. Depression medication altered during admission. Should the principal diagnosis be R45.89 Other symptoms and signs involving emotional state or F32.90 depression or should both be coded?
2.If a patient is admitted with situational crisis due to relationship issues and is documented as having associated conditions Alcohol dependence (which meets ACS002). Should the principal diagnosis be situational crisis R45.89 Other symptoms and signs involving emotional state or F10.2 (as this is a condition classifiable to Chapter 5) or should both be coded?
Where 'situational crisis' is documented, coders should look for documentation within the clinical record or seek clarification from the treating clinician to determine if the patient has a condition classifiable to Chapter 5 Mental and behavioural disorders (F00-F99) for example, an acute stress reaction or an adjustment disorder.
If documentation or clinical advice clarifies that the patient has a mental or behavioural disorder, assign an appropriate code from F00-F99.
Does there have to be a direct link/relationship between the patient's situational crisis and the patient's chapter 5 mental & behavioral disorder?
For example
1. Patient admitted for situational crisis with past history of depression. Depression medication altered during admission. Should the principal diagnosis be R45.89 Other symptoms and signs involving emotional state or F32.90 depression or should both be coded?
2.If a patient is admitted with situational crisis due to relationship issues and is documented as having associated conditions Alcohol dependence (which meets ACS002). Should the principal diagnosis be situational crisis R45.89 Other symptoms and signs involving emotional state or F10.2 (as this is a condition classifiable to Chapter 5) or should both be coded?
Response
VICC referred this query to ACCD who provided the following response:
Situational crisis is a culturally acceptable, normal reaction to a stressful life event, such as the death of a family member or threatened job loss.
If, however, the symptoms are ongoing, beyond normal, acute stress or are more intense, it becomes a problem of adjustment and the ongoing symptoms are now considered to have developed into a disorder. This may be described as a situational crisis, but the main problem is one of adjustment.
Where 'situational crisis' is documented, coders should look for documentation within the clinical record or seek clarification from the treating clinician to determine if the patient has a condition classifiable to Chapter 5 Mental and behavioural disorders (F00-F99) for example, an acute stress reaction or an adjustment disorder classifiable to category F43 Reaction to severe stress, and adjustment disorders.
If documentation or clinical advice clarifies that the patient has a mental or behavioural disorder, assign an appropriate code from F00-F99.
When clinical advice is unavailable or there is uncertainty regarding whether the patient has an acute stress reaction or adjustment disorder, assign R45.89 Other symptoms and signs involving emotional state.
Improvements to the Alphabetic Index will be considered for a future edition of ICD-10-AM.[end of ACCD response].
VICC interprets the ACCD response to mean that there needs to be a documented relationship between the patient's mental health condition and the situational crisis before a code from F00-F99 can be assigned as principal diagnosis. Clinical coders should not assume that the patient's mental health condition is the underlying cause of the situational crisis.
In the absence of supporting documentation or documented clinical clarification R45.89 Other symptoms and signs involving emotional state is assigned as principal diagnosis and an additional code for the patient's mental health condition is assigned if it meets ACS 0002 Additional diagnoses.
Where the documentation supports a relationship between the situational crisis and the mental health condition a code for the condition can be assigned as principal diagnosis and R45.89 Other symptoms and signs involving emotional state is not assigned.
Situational crisis is a culturally acceptable, normal reaction to a stressful life event, such as the death of a family member or threatened job loss.
If, however, the symptoms are ongoing, beyond normal, acute stress or are more intense, it becomes a problem of adjustment and the ongoing symptoms are now considered to have developed into a disorder. This may be described as a situational crisis, but the main problem is one of adjustment.
Where 'situational crisis' is documented, coders should look for documentation within the clinical record or seek clarification from the treating clinician to determine if the patient has a condition classifiable to Chapter 5 Mental and behavioural disorders (F00-F99) for example, an acute stress reaction or an adjustment disorder classifiable to category F43 Reaction to severe stress, and adjustment disorders.
If documentation or clinical advice clarifies that the patient has a mental or behavioural disorder, assign an appropriate code from F00-F99.
When clinical advice is unavailable or there is uncertainty regarding whether the patient has an acute stress reaction or adjustment disorder, assign R45.89 Other symptoms and signs involving emotional state.
Improvements to the Alphabetic Index will be considered for a future edition of ICD-10-AM.[end of ACCD response].
VICC interprets the ACCD response to mean that there needs to be a documented relationship between the patient's mental health condition and the situational crisis before a code from F00-F99 can be assigned as principal diagnosis. Clinical coders should not assume that the patient's mental health condition is the underlying cause of the situational crisis.
In the absence of supporting documentation or documented clinical clarification R45.89 Other symptoms and signs involving emotional state is assigned as principal diagnosis and an additional code for the patient's mental health condition is assigned if it meets ACS 0002 Additional diagnoses.
Where the documentation supports a relationship between the situational crisis and the mental health condition a code for the condition can be assigned as principal diagnosis and R45.89 Other symptoms and signs involving emotional state is not assigned.
