Q&A: Schizophrenia “unspecified” versus “other specified”

Q: I have a question about coding “unspecified” versus “other specified,” as to whether schizophrenia, multiple episodes, acute exacerbation, is coded as schizophrenia, unspecified. The new ICD-10-CM/PCS Official Guidelines for Coding and Reporting do not explain whether paranoid, disorganized, undifferentiated, etc., is required language.

A: You are correct ICD-10 differs from ICD-9 in the fact that we no longer code schizophrenia based on subtype and acuity. In ICD-10-CM, they eliminated the acuity and updated the subtypes. The updated classification of schizophrenia now includes the subtypes paranoid, disorganized, catatonic, undifferentiated, residual, and other.

Since the descriptors “multiple episodes” or “acute exacerbation” do not equate to a specific subtype of schizophrenia, the coder would have no alternative than to code schizophrenia-unspecified in this instance. The physician must document the specific subtype of schizophrenia for the coder to apply a more specific code. “Other schizophrenia” includes codes for schizophreniform disorder, as well as cenesthopathic schizophrenia, and simple schizophrenia, and would also only be applied based on provider documentation to support use of these codes.

This would be a great teaching opportunity for you and your physicians, to help them understand that, even though they may think they are giving us the needed documentation for proper code assignment, they may not be. I would make sure they understand that, although documenting the acuity and frequency of a condition and/or manifestation is good, sometimes it is not enough for proper code assignment. These details can often lead to a more specific code that will represent a patient’s condition more accurately, lead to better quality documentation, and possibly increase severity of illness/risk of mortality and reimbursement.

Editor’s note: Sharme Brodie, RN, CCDS answered this question. Brodie is a CDI education specialist for ACDIS and HCPro in Middleton, Massachusetts. Contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com.