The New ICD-10 Codes for Mental Health & Deletion of Prolonged Services Codes: What This Means for You

Leave a Comment / Insurance Billing / By

The new ICD-10 codes for mental health are coming into effect in 2023, but what do they mean for you?

In addition, starting January, 1st, 2023 there are some major deletions to some of our most frequently used CPT Codes! CPT is deleting prolonged codes 99354, 99355, 99356, and 99357. These were face-to-face prolonged service codes. Many of us use these for extended sessions with our clients and particularly with our EMDR clients and family sessions that go longer than 90 min. Please take note of these major changes and change your billing accordingly.

Here is a summary of the ICD-10 updates and the DSM 5 codes.

ICD-10-CM includes an official Index and official Guidelines of mental health diagnoses. These are designed to help people coding claims to find and assign the correct diagnosis codes for their client’s conditions. Some are billable and some are not. Each year these codes get updated, just to confuse us all. lol!!

therapist checking ICD Codes guidelines

What are the new ICD-10 codes for mental health and what do they mean for you?

The most important codes I want to focus on today is:
  • F43.8 Other Specified Trauma and Stressor-Related Disorder
  • F11.92 Opioid use, unspecified with intoxication.  
  • F20.4 Schizophrenia, schizophrenic undifferentiated 
As I understand the changes right now, if you use to use F43.8 – Other Specified Trauma and Stressor Related Disorder for any clients, you’ll need to update that to F43.89 for Other reactions to severe stress, because F43.8 will start to get denied for payment because this code has demoted, so to speak. F43.8 now means Reaction to severe stress, and adjustment disorders (F43) and it is no longer considered a valid code for billing purposes.
 
A new code in the F.43 category is code F43.81 – Prolonged grief disorder
 
Non-specific codes like F43.8 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for other reactions to severe stress:
  • BILLABLE CODE – Use F43.81 for Prolonged grief disorder
  • BILLABLE CODE – Use F43.89 for Other reactions to severe stress
 
Changes in Codes:
Schizophrenia, schizophrenic undifferentiated F20.4 has been revised to residual Schizophrenia F20.5. you will have to bill that now.
https://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F20-/F20.5
 
Schizophrenia, unspecified is now to F20.9 
https://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F20-/F20.9

Codes for Substance Use:

 
New
F10.90 Alcohol use, Unspecified, uncomplicated – https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F10-/F10.90
 
F10.11 Alcohol abuse, unspecified, in remission – https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F10-/F10.11
 
Removed
F11.92 Opioid use, unspecified with intoxication. should not be used for reimbursement purposes as there are multiple codes that contain a greater level of detail.

All of the billable Mental Health Codes can be found here pages 41-50.

https://www.icd10data.com/ICD10CM/Codes/Rules/Billable_Specific_Codes/47

New Codes - A Complete List can be found here

https://www.icd10data.com/ICD10CM/Codes/Changes/New_Codes/1?year=2023

What changes do you need to make to prepare for the new codes in 2023?

You will need to change any diagnosis that has been removed from the billiable codes for ICD-10 to a more accurate diagnosis. If you were using any of the prolonged session billing codes, please take note and adjust accordingly.  I’m keeping an eye on these changes and hope there will be a solution to allowing us to continue with extended sessions when justified. 

Final thoughts on the new ICD-10 codes for mental health.

With more accurate diagnoses, patients will be able to get the most appropriate treatment for their condition. The new codes are also important because they’ll help to reduce the number of misdiagnoses. Misdiagnoses can result in patients not receiving the correct treatment, which can lead to further complications.
 
Preparation is key for making the switch to the new ICD-10 codes for mental health. Make sure you understand how the changes will impact your coding, and be sure to update your software and billing procedures accordingly.
 
If you have any questions, don’t hesitate to reach out to myself or sign up for our billing membership community where we keep you up to date on all of the latest changes like this and walk you through any billing difficulties you encounter at www.privatepracticeinsurancebilling.com
 
Click subscribe on my YouTube Channel to get helpful tips and tricks about insurance billing and private practice, and a ton of free resources to help you with topics like this one.

Leave a Comment

Bill Like A Boss:
Maximize Your Profits

Copyright © 2020 Private Practice Telehealth Insurance Billing

Facebook-f Envelope
Scroll to Top