What ICD-10 Code is for Profound Intellectual Disabilities?

The ICD-10 Code for Profound Intellectual Disability

Those who struggle with intellectual disabilities have neurological developmental deficiencies that limit their intellectual reasoning and adaptive functioning. An individual with a profound intellectual ability is characterized by intellectual and adaptive functioning deficits more than four standard deviations below the mean or less than approximately less than the 0.003rd percentile.

Up to 3% of all people in the U.S. suffer from some form of intellectual disability. The adaptive and intellectual deficits typically start during childhood. Most people grappling with an intellectual ability deal with it in its milder forms. The World Health Organization (WHO) has developed an International Classification of Disability and Health to provide a framework for classifying intellectual impairment. 

In addition, the WHO’s ICD-10 coding system identifies the different intellectual disability codes in the F70-F79 range. Likewise, the CDC’s national classification for disabilities can be found in Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F79). This article will explore the importance of ICD-10 codes and how they assist providers in accurately diagnosing profound intellectual disabilities, namely F73. 

How Do ICD-10 Codes Help With Health Documentation and Statistics?

The 10th revision of the International Classification of Diseases (ICD-10) was put into effect, after several delays, on October 1, 2015. The WHO is currently developing the 11th revision to ensure the coding system remains aligned with modern medical standards and practices.

The ICD-10 diagnostic coding system replaced 10-9, which was first published in 1977. This transition to a considerably different classification model impacted how clinicians and healthcare providers delivered their services.

The ICD-10 contained tens of thousands of more codes than ICD-9. The inpatient procedure code set (PCS) also changed significantly in the transition to ICD-10. The WHO introduced its updated international disease classification system to correspond with the increasing complexity of modern medical documentation requirements. 

Countless new procedures and devices have been introduced since the publication of ICD-9. These new treatments and technologies must be accurately coded to maintain acceptable health records. The transition to the ICD-10 coding set adapted to the latest intricacies and developments in healthcare, allowing providers to code them more accurately in their records.

International disease data collection also benefited substantially after the transition to ICD-10. The 10th revision provides more space for documenting treatable conditions and their outcomes. ICD-9, for example, could not account for similar injuries on opposite limbs. ICD-10 also lets providers classify disease and injury severity in addition to more conditions that weren’t covered in ICD-10. 

The more thorough ICD-10 diagnostic system offers more accurate coding, leading to more efficient claims processing and fewer denied claims. ICD-10 also provides more detailed information to global health agencies and other healthcare providers delivering subsequent services to the client. 

ICD-10 Enhances the Safety and Quality of Client Care

Since the more accurate coding system in ICD-10 better reflects the overall state of the individual, the revised classification system gives clinicians an improved tool for evaluating safety and quality measures. The ability to more thoroughly document client conditions helps avoid claims denials and can have a significant impact on how insurers deliver payments to the hospital. 

The extra detail in the ICD-10-CM and -PCS codes, and their capacity to accommodate new devices and procedures, offers more reliable data for evaluating and improving the quality of client care. Doctors and medical researchers can apply the additional data to robust clinical algorithms while they track individual outcomes with more precision. 

The ability to decipher disease and injury severity also helps illustrate the quality of the provider’s care in relation to the client’s condition. Since the ICD-10 codes were expanded so significantly, providers can develop additional safety precautions for the specific conditions. 

The more thorough data sets also give providers and insurers more accurate data about the efficacy of outcomes and the costs of newer procedures and technologies. The more precise alphanumeric coding lets payers and providers establish fair reimbursement policies.

ICD-10 and Data Sharing

The International Classification of Disease system has a long history, dating back to the late 18th century. Its original intent was to develop a more universal system for cataloging vitality statistics among the various industrialized nations across the globe. Before the original Bertillon Classification of Causes of Death, as it was first called, existed, there was essentially no reliable standard for sharing public health data across international borders.

These limitations, of course, made it a challenge to track and respond to global disease trends in times when it was most critical. The WHO modernized the original system for classifying morbidity data shortly after the resolution of the Second War in 1948. The health organization compelled members, such as the U.S., to use this modern ICD system to detect and verify emergent disease threats.

The idea behind such a system says that every country should have a platform for detecting and rapidly responding to a worldwide health crisis, like the COVID-19 pandemic, to minimize its threat against the world population. The ICD-10-CM system adopted by the U.S. also helps facilitate an analysis of the safety and quality measures in healthcare technology and procedures across multiple global languages and cultures. 

The ICD-10 has proven substantially more efficient at recording public health data than the previous 9th revision. It provides more specificity for documentation purposes. The updated diagnostic system gives medical researchers, clinicians, and insurers an improved means of capturing reportable diseases and other serious biological threats. 

Classifying Intellectual Disabilities With ICD-10

In medicine and behavioral health, an intellectual disability or intellectual developmental disorder describes an individual with below-average intellectual and adaptive functioning. To diagnose people with an intellectual disability, they must undergo an individually administered clinical assessment that entails validating standardized testing of the person’s intellectual functioning and adaptive behavior. 

This evaluation most often occurs sometime between infancy and adolescence when the symptoms are usually observed. The WHO classification describes intellectual disabilities as “diverse conditions originating during the developmental period characterized by significantly below average intellectual functioning and adaptive behavior.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that deficits in intellectual reasoning include issues with problem-solving, abstract reasoning, scholastic learning, and learning from experience. Before diagnosing an intellectual disability, doctors and behavioral health specialists assess the primary components of intellectual functioning and evaluate criteria such as verbal comprehension, working memory, and quantitative reasoning. 

The WHO’s internationally accepted system for classifying intellectual disabilities evaluates adaptive functioning in relation to conceptual, social, and practical domains. If a person displays an adaptive deficiency in these areas, they will have trouble meeting several standard developmental and sociocultural standards that lead to a fully independent lifestyle. 

In ICD-10, The WHO breaks down borderline intellectual functioning categories as follows: 

  • F70. Mild intellectual disabilities
  • F71. Moderate intellectual disabilities
  • F72. Severe intellectual disabilities
  • F73. Profound intellectual disabilities
  • F78. Other intellectual disabilities
  • F79. Unspecified intellectual disabilities

The vast majority of people affected with intellectual ability usually fall under the F70 code for mild intellectual disabilities. To be diagnosed under this classification, the client must display measured intellectual and adaptive functioning two to three standard deviations below the mean. The mildly intellectually impaired have IQ scores between 50 and 70, and the average IQ is 100. 

Mild intellectual disabilities are characterized by difficulty in comprehending complex language and academic concepts. Typically, those with mild intellectual disabilities don’t reach literacy and mathematical abilities beyond the 4th or 5th grade level. The mildly intellectually impaired can, however, develop basic reading, writing, and arithmetic skills after receiving the appropriate learning support.

Moderate intellectual disabilities impact roughly 10% of those diagnosed with an intellectual disability. The IQ for people in this category is between 35 and 50. Children with moderate intellectual disabilities take longer to develop basic literacy skills and will struggle to gain even limited academic proficiency. With the appropriate support, however, the moderately intellectually impaired can develop early elementary skills such as number matching and sight-word reading. 

Severe intellectual disability impacts roughly 4% of the population diagnosed with the impairment. People usually develop severe intellectual impairment before age 3. Like profound intellectual impairment, discussed in more detail below, this level of intellectual disability requires four or more standard deviations below the mean or less than approximately the 0.003rd percentile. Measured IQs for this classification fall between 20 and 35.

The ICD-10 F73 Code for Profound Intellectual Disabilities

ICD-10 code profound intellectual is F73. Roughly 1% of all people diagnosed with an intellectual disability fall under the profound category. To be diagnosed with a profound intellectual disability, the person needs to display intellectual and adaptive functioning four or more standard deviations below the mean. 

Those with profound intellectual have an IQ below 20 and have problems completing basic tasks such as administering self-care. As such, they may require custodial or hospitalized assistance and may be completely dependent on a legal guardian. Oftentimes, people with a profound intellectual ability also display motor and sensory dysfunctions that prevent them from developing basic adaptive skills. 

The F73 code designating profound intellectual is helpful for distinguishing between the other intellectual disabilities in which the client may have significantly more capacity for adaptive learning. Likewise, care providers can subsequently develop the appropriate care and treatment plans, which would differ considerably from those with mild intellectual impairment, for example.

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