Puerperal Psychosis ICD-10 Codes

Physicians who work with pregnant women have a rare chance of coming across a client with puerperal psychosis. Reports indicate that one out of every 1,000 mothers develop the disorder. You’ll also notice that many doctors use the term interchangeably with postpartum psychosis. In addition to knowing the ICD-10 code for puerperal psychosis, you may want to learn more about the symptoms and treatments to assist your clients better.

What Is Puerperal Psychosis?

Also known as PPP, puerperal psychosis is a psychiatric disorder that occurs during the postpartum period. While more than 80% of women have mood changes during this period, 15% or less have symptoms that last beyond the postpartum era. This period begins when the woman gives birth and lasts for multiple months or longer. Though some doctors believe it’s a manic episode associated with bipolar disorder, it can be present in women who do not have bipolar disorder. Women often develop symptoms within 72 hours of delivering a child. Others experience the first symptoms within the first two weeks.

PPP Symptoms

Before you add the PPP ICD-10 to a client’s file, make sure you diagnose her correctly. The symptoms of PPP include physical and emotional signs. Women may feel a range of emotions that run from excitement to depression, which mimic bipolar episodes. Those episodes can last for hours, days, or longer. 

Rapid mood changes are also common as the woman fluctuates between her emotions. She may feel happy and excited about being a mother one day and so depressed and upset on another day that she doesn’t want to get out of bed. Confusion and disorientation are also common. Women may have a hard time getting a handle on their feelings, which causes them to feel confused about what they want. Doctors usually divide the symptoms into depressive and manic symptoms.

Depression Versus Mania

An easy way to think about depression and mania is that one represents highs while the other represents lows. The symptoms of mania include:

  • Needing less sleep than usual but still having the same amount of energy or more energy
  • Having an inability to finish thoughts or sentences when talking to others
  • Feeling like nothing can keep you down or stand in your way
  • Making plans for the future you cannot keep
  • Struggling with frequent or constant mood swings
  • Spending more money than you can afford to spend
  • Feeling or acting happier than you usually are
  • Engaging in risky or dangerous behaviors, such as sexual activities
  • Exhibiting trouble concentrating or completing simple tasks
  • Suffering from hallucinations or delusions

Delusions and hallucinations are some of the more dangerous signs of PPP. Women who suffer from hallucinations can see or hear things that are not there. They may believe they hear someone telling them to do things, such as spend money they don’t have or go to a bar. 

While hallucinations are visual and auditory, delusions exist within the woman’s mind. Delusions cause her to think things are true that are false. They can affect the relationships she has with others as well as her new baby. Manic delusions can cause her to act out, too. She may attempt to harm the baby because she thinks the child will harm her. If she believes the baby is in danger, she will go to great lengths and sacrifice her own safety to protect the child.

The depressive symptoms are similar but also mimic the symptoms of depression:

  • Inability to handle normal chores or activities
  • Suffering from insomnia or having trouble sleeping through the night
  • Showing a loss of interest in things you enjoyed doing in the past
  • Feeling a lack of energy during the day
  • Experiencing thoughts of suicide or self-harm
  • Pulling away from loved ones and friends
  • Feeling hopeless when it comes to caring for your baby
  • Appearing depressed, sad, or down

Hallucinations and delusions are common during a depressive episode, too. Hallucinations often include voices telling her she can’t handle being a mother or challenging her actions. She may listen to those intrusive thoughts and give up on caring for her baby. The voices can also focus on the things she thinks she does wrong, such as how she feeds the baby or changes a diaper. PPP delusions usually relate to the woman and not the child. She might think she should not hold the baby or feed the child because she’s a bad person who doesn’t deserve to be a mother. 

Puerperal Psychosis Diagnosis

As a doctor working with a recent mother, you cannot diagnose PPP based on a single appointment or with a simple test. One way to help your client is with a series of questions you ask when taking her medical history. First, ask if she received a mental health diagnosis in the past. Postpartum psychosis is more common among women who have a family history of PPP and those who received treatment for a mental disorder in the past. Mental disorders that put a woman at risk of developing PPP include anxiety, depression, and bipolar disorder. You’ll also want to determine if she has a history of substance abuse or experiences thoughts of self-harm or harming her baby.

As a primary care physician, you can rule out other conditions that cause some of her symptoms. You don’t want to diagnose a woman with PPP when she has an underlying condition. Perform tests to check her hormone levels and white blood cells. A large increase or decrease in her hormones may cause her to act in unusual ways. It’s also important to ensure she has PPP and not postpartum depression, as they require similar but different treatments.

Treatment for PPP

The treatments for PPP include medications and therapy. Women who experience hallucinations or delusions often respond well to antipsychotic medications. The medications help her clear her mind and prevent her from seeing and hearing things that are not there. It’s helpful for women to have a support group of loved ones to ensure they take the prescription as directed. Mood stabilizers also work, especially for women in the midst of a manic episode. Some women need to take multiple medications or a combination of drugs to treat all of their symptoms.

Electroconvulsive therapy, or ECT, is another successful treatment option. Though often performed in an inpatient setting, doctors can also offer it on an outpatient basis. This is also a popular treatment for those with other forms of depression or bipolar disorder. It involves stimulating the brain via a small electrical shock. Doctors put individuals to sleep before administering the treatment. Clients often see the doctor up to three times a week for a total of 12 sessions. New mothers suffering from PPP can go through their insurance provider to see if their policies cover ECT.

ICD-10 Code for Puerperal Psychosis

The International Classification of Diseases (ICD) is a coding system used to help medical professionals diagnose their clients. While the ICD-9 became available in the 1970s, it contained some outdated data that led to the 10th edition and new ICD-10 codes. Though puerperal psychosis appeared in early versions of the ICD, you must now use the code found in the 10th edition.

The basic code for the disorder is F53. If a client has postpartum depression, you would use the similar F53.0 code. When you bill a client’s insurer, make sure to use the code F53.1, which is the billing code. This helps the insurance provider reimburse you for any coverage you supplied. This code applies to women between the ages of 12 to 55 and to both puerperal psychosis and puerperal psychosis NOS, which is when the disorder is not otherwise specified. This simply means the physician cannot provide a complete diagnosis and that the woman may need more help.

Why Use ICD-10 Codes?

The World Health Organization (WHO) designed ICD codes as a way to standardize health care around the world. Though some countries use different codes, most rely on the WHO codes. Whether you see people who just immigrated to the United States or clients who visited multiple doctors before, the codes in their files let you know what conditions they have and any treatments they received. 

ICD Codes for ER Doctors

Doctors working in emergency rooms and centers are not familiar with the clients they see. While they may have some regulars, they often work with a variety of clients daily. If you saw a woman early in her pregnancy, helped her give birth, and continued seeing her later, you are familiar with her case and can look for the signs of PPP or another postpartum condition. Working in the ER means you might see women who are pregnant, about to give birth, or already have a child. Since you know little about her, you need to use the codes in her file.

A psychiatric emergency occurs when an individual exhibits symptoms that require her to seek help or someone forces her to seek help. The problem is that a woman may visit the ER for another issue and not her PPP. She may come in because she’s frantic her baby is sick. ER doctors also see women who hide their symptoms because they want to leave and get home to their babies, especially if they have delusions or hallucinations that someone or something will hurt the child. You risk treating a simple problem and sending the woman home without realizing it’s an emergency.

It’s often hard for new doctors to spot the signs of PPP because the women will appear scared and worried in the same way that other mothers will. Around 5% of women commit suicide or infanticide during a PPP episode. You should never send a new mother home without making sure she isn’t a risk to herself, her child, or anyone in her home. One way to look for symptoms of PPP is with a few questions, such as whether she hears or sees things that aren’t there and if she believes someone wants to harm her or the baby.

ICD-10 codes help in two ways. The first is that they allow you to see the diagnosis before you treat the woman. If you see F53 or a similar code in her chart, you know she needs more help than another mother. You may want to stabilize her in the ER before she goes home or provide her with a dose of the medication she missed or stopped taking. It’s equally important that you keep her in the hospital if she is a danger to others. ER doctors can hold women and get them the psychiatric help they need.

Using the right code is also important because you may be the first one to notice the symptoms. This can happen if the woman doesn’t have a primary care doctor or if she sees multiple doctors. When you add the puerperal psychosis code to her record, it follows her, especially if she sees other doctors in your health care system. As soon as they see the F53 code, they know she has or had PPP. The code also lets you take steps to keep her safe. You may need to remove the child from the room before you treat her or call a psychiatrist in your facility for more help.

Monitor Clients and More

Maintaining accurate records helps you monitor clients who may develop puerperal psychosis, postpartum depression, or other conditions. Your documentation is also vital for other professionals involved in a client’s care. In a fast-paced environment, keeping up with all the notes you need to take about your clients may be challenging. AutoNotes makes clinical note generation effortless and efficient by leveraging AI. With our user-friendly platform, you can generate comprehensive documentation in just a few clicks. You can then copy your AutoNotes into your EHR system, allowing you to get your notes done faster without sacrificing patient care.