What to Know About the ICD-10 Diagnostic Codes for Behavioral Health

The International Classification of Disease system has a long and storied history in organized medicine, dating back to 1763. Medical scholars attribute the invention of the ICD codes to the French physician and botanist Dr. François Bossier de Sauvages de Lacroix, the first physician to establish distinct disease categories. 

The contemporary healthcare system has been using ICD-10 codes for nearly 20 years (and exclusively since 2015). These diagnostic coeds impact virtually every aspect of the industry. Both medical billing and diagnoses rely on ICD-10’s alphanumeric combination that identifies the disease and its symptoms along with any procedures administered by the provider. We’ll explore why ICD-10 codes matter and how they benefit the behavioral health sciences in particular.

An Early History of the ICD Classification System

Sauvages de Lacroix advanced his work from 10 distinct disease classes to 2,400 uniquely identifiable ailments. The medical scientist and physician based his own classification efforts on earlier studies by Thomas Sydenham, an English physician who drew from the methods of contemporary botanists at the time. 

In 1853, Western Europe held its first International Statistical Congress in Brussels, Belgium, to develop an ICD classification. This new system initially called the “International List of Causes of Death,” was to be utilized across Europe’s various international languages and borders. By late 1898, the United States and other North American countries adopted the International List of Causes of Death as an agreed-upon system for cataloging mortality data. 

This early ICD system had a major update shortly after World War II: In 1948, the World Health Organization (WHO) assumed control over the ICD classification system. Shortly thereafter, WHO assumed control of the then-International List of Causes of Death. In 1949, the private international health organization expanded the system to include modern ICD coding while renaming it the International Classification of Disease System.

The first five editions of the ICD diagnostic coding system were contained within a single volume that included an alphabetical index and a tabular list. By ICD-6, the coding had expanded to two volumes that included a comprehensive list of psychiatric and behavioral health disorders. After the eighth revision conference in 1967, WHO referred to the latest edition as the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death.

Scientists and health officials at WHO continued making revisions regularly. In accordance with WHO standards, the United States Public Health Service adopted the ICD as an index for documenting national hospital records and surgical procedures.

The Modern ICD Diagnostic Coding System

The WHO eventually formed its Department of Knowledge Management and Sharing of the World Health Organization, publishing ICD-9 in 1977. The updated publication was the first to offer four-digit-level codes and included an optional five-digit subdivision for cataloging disease. ICD-9 also marked the first revision to enter the public domain. The ICD-9-Clinical Modification (CM) represented a subsequently expanded version of that edition that initially appeared in the United States. 

The ICD-9-CM version expanded to a three-volume set and enabled inpatient, outpatient, and medical office staff utility. The National Center for Health Statistics played a prominent role in fostering this change, while the ICD-9-CM was decidedly more effective at capturing morbidity data and easier to update. 

The inpatient Prospective Payment System, introduced in 1983, used ICD-9-CM to facilitate hospital care payments for the chronically diseased and senior citizens participating in the U.S. Medicare program. The work on ICD-10 began in the early 1990s. The initial public comment phase started in 1992, and the 10th revision included far more detail, expanding from 17,000 codes to more than 155,000. 

While countries like Canada adopted ICD-10-CM codes as early as 2000, it wasn’t until January 2009 that the U.S. Department of Health and Human Services announced its intent to replace ICD-9 with ICD-10. The hierarchical structures of ICD-CM-10 and ICD-9-CM are essentially the same. ICD-10-CM, however, contains both letters and numbers along with the new potential to express code up to seven digits in length, excluding the letter U. 

ICD-9 was limited to five digits and did not include valuable information concerning ambulatory and managed care. ICD-10 also added injury codes to more accurately depict the condition and site of injuries. 

Officials slated the initial rollout for ICD-10 for Oct. 1, 2013. In light of the sweeping changes to the updated publication, the switch was delayed to Oct. 1, 2015. This effective date was, likewise, solidified into the Protecting Access to Medicare Act of 2014, requiring all U.S. healthcare providers and government agencies to adopt ICD-10.

The transition from ICD-9 to ICD-10 took longer than the previous updates because of the costs associated with implementing such a complex digital tracking system. The increased granularity of ICD-10, however, has been more effective for documenting diseases worldwide while offering a more streamlined system for delivering healthcare in the United States. 

ICD-10 allows for sophisticated tracking tools, such as those offered by AutoNotes, that enable better patient outcomes and improved financial documentation. In turn, the more detailed coding helps U.S. providers emphasize the value of the treatment instead of volume as they push to lower the costs of delivering quality health care in the country. 

The new ICD-10-CM, while more accurate, isn’t without controversy. As mentioned, the costs of implementing the new universally imposed medical records tracking system were viewed by some healthcare professionals as excessively high. With that, it wasn’t universally supported by all payers. Other regulatory requirements introduced in the Affordable Care Act also made the switch to ICD-10 a challenge for some providers. 

One of the upsides of ICD-10, however, is that it could eliminate the Current Procedural Terminology (CPT) codes developed in the mid-1960s to account for IDC’s lack of specificity. The current patient reimbursement system in the U.S. relies on these codes to calculate the cost of The Centers for Medicare and Medicaid Services (CMS). Insurers have been known to misuse CPT codes to hide administrative costs. Getting rid of them could help lead to greater transparency among the healthcare giants to reduce wasteful spending on public programs like Medicare. 

What Constitutes Behavioral Health in the Healthcare Industry?

According to the American Medical Association, behavioral health can refer to a multitude of disorders related to both substance use and mental health. Clinical issues that pertain to mental health can range from disruptive crises and major life stressors to depression-induced physical symptoms and even schizophrenia. Behavioral health care consists of the prevention, diagnosis, and treatment of such conditions.

Behavioral health practices are also closely intertwined with modern psychiatry and psychology because they seek to examine and explain how thoughts and emotions influence human behavior. The field deals with various behaviors, such as lifestyle patterns, interpersonal relationships, mental health, and substance use. The field’s primary objective is to help clients and patients understand the underlying issues motivating their thought processes and the emotional responses that accompany them.

In general, behavior healthcare specialists benefit the wider healthcare industry by:

  • Enabling better access to appropriate services
  • Fostering more positive patient outcomes
  • Adding value and reducing costs for long-term treatments
  • Lowering the risk of self-harm
  • Reducing treatment gaps in mental health services
  • Improving patient and client satisfaction levels

Behavioral health services form an overarching branch of care that seeks to bridge medical, mental, and addiction treatments to address a client’s overall healthcare needs. This particular field has been increasingly integrated into primary care services. Providers have several options for selecting the most effective approach to behavioral health services based on the size of their organization and its available technology. The AMA distributes behavioral health how-to guides that provide actionable advice to physicians and other primary care providers.

What Are the Principal ICD-10 F Codes for Mental and Behavioral Development Disorders?

Under the ICD 10th revision, the diagnostic codes for behavioral health disorders start with the letter F. Here’s how the main F categories break down:

F01 to F09: Behavior Disorders Attributable to Known Physiological Conditions

The codes in this range deal primarily with conditions like dementia and delirium associated with a known physical condition, such as a vascular problem. F06 covers unknown mental disorders ascribed to a known physical condition. 

F10 to F19: Behavioral Disorders Attributable to Psychoactive Substance Use

This series of F codes primarily covers behavioral health problems as they relate to substance use disorder (SUD). They specify the mental health symptoms linked to using everything from opioids to nicotine. 

F20 to F29: Schizophrenia or Schizotypal Delusional, Non-Mood Psychotic Disorders

These F codes designate the mental symptoms associated with a schizophrenic diagnosis. They focus principally on the range of psychotic symptoms that clients who suffer from the disorders often present. 

F30 to F39: Mood Affective Disorders

This series of codes covers mood disorders such as mania, major depressive disorder, and bipolarism. These F codes home in on several common mental health conditions while including categories for others that remain unclassified.

F40 to F48: Anxiety and Stress-Related Non-Psychotic Disorders

These F codes outline the various anxiety disorders, from phobia to obsessive-compulsive disorder. They also cover dissociative states and general reactions to stress.

F50 to F59: Behavioral Syndromes Linked to Physiological Factors

This section classifies eating and sleeping disorders as they relate to known physiological conditions. It includes other health conditions like sexual dysfunction unrelated to substance use.

F60 to F69: Adult personality and behavioral disorders

Impulse, adult personality, and other behavior disorders are listed under this section. It can cover a range of unspecified personality disorders. 

F70 to F79: Intellectual disabilities

These F codes hierarchize the range of potential intellectual disabilities patients can face. The latter codes cover “other” and “unspecified” intellectual disabilities. 

F80 to F89: Specific and Pervasive Developmental Disorders

This section of codes pertains to speech disorders, particularly as they relate to personal development and the patient’s scholastic capabilities. They focus on how speech disorders contribute to other developmental social problems.

F90 to F98: Early Onset Behavioral and Emotional Disorders

Behavioral and mental health problems associated with childhood and adolescence are cataloged in this range of ICD-10 F codes. Any documented symptoms attributable to a patient’s upbringing, for instance, would be classified here. 

F99 to F99: Unspecified Mental Disorder

In the unlikely event that a disorder couldn’t be classified, it would be documented as F99.

What Are the Main ICD-10 Z Codes for Behavioral Health?

The ICD-10 Z codes deal with additional social determinants as they pertain to mental health. The following societal conditions are self-explanatory. They can often lead to specific mental and behavioral symptoms. Properly identifying these social determinants will help caregivers deliver a holistic approach for better treatment outcomes. 

  • Z55 to Z55.9 – Literacy and education problems
  • Z56 to Z56.9 – Employment-related concerns
  • Z57 to Z57.9 – Occupational exposure to risk factors
  • Z59 to Z59.9 – Poor housing and economic circumstances
  • Z60 to Z60.9 – Unfavorable social environment
  • Z62 to Z62.898 – Poor childhood upbringing
  • Z63 to Z63.8 – Problems sourced to a primary support group
  • Z64 to Z64.4 – Unfavorable psychosocial circumstances
  • Z75.3 to Z75.4 – Problems related to healthcare access

Using AutoNotes for Improved Behavioral Health Documentation

The concise and detailed ICD-10 codes help behavioral health specialists develop the appropriate treatment plans for complex conditions like dementia, anxiety, and major depressive disorder. They also improve communication across all areas of healthcare through more efficient medical coding processes. 

AutoNotes offers an easy-to-understand platform to streamline your ICD-10 coding medical billing processes to help you save valuable time and minimize the risks associated with documentation errors. If your clinic or healthcare agency spends too much time documenting behavioral health issues and needs more efficient medical coding solutions in general, consider trying AutoNotes for free.