The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), is a critical resource for mental health professionals. While primarily a diagnostic manual, it also interfaces with the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for coding purposes. This article clarifies a significant update to the DSM-5 and ICD-10-CM coding system: the inclusion of a “no diagnosis or condition” category and the related ICD-10-CM code, Z03.89. This addition, along with other key updates, particularly concerning substance withdrawal, ensures more accurate and comprehensive clinical coding.
The “No Diagnosis or Condition” Category: Code Z03.89
Prior to May 2018, the DSM-5 classification lacked a specific category for instances where, after examination, no diagnosis or condition was determined. Recognizing this gap, the DSM-5 Steering Committee approved the inclusion of “No diagnosis or condition.” The corresponding ICD-10-CM code for this category is Z03.89. This code is essential for accurately documenting encounters where mental health evaluations are conducted, but no disorder is identified. It provides a crucial option for clinicians to reflect the outcome of an assessment when a diagnosis from the DSM-5 is not applicable.
Key ICD-10-CM Code Updates in DSM-5
Beyond the introduction of the “no diagnosis” code, the DSM-5 also incorporated several other important ICD-10-CM code updates, particularly concerning substance-related disorders. These changes, effective from October 1, 2018, refine the coding for withdrawal syndromes and factitious disorders.
Withdrawal, Without Use Disorder Codes
A notable update involves the differentiation of withdrawal syndromes based on the presence or absence of a substance use disorder. Previously, the DSM-5 coding didn’t explicitly include codes for withdrawal in the absence of a diagnosed substance use disorder. The updated ICD-10-CM codes address this by providing specific codes for withdrawal states without a co-occurring use disorder. These include:
- Cannabis withdrawal, Without use disorder: F12.93
- Opioid withdrawal, Without use disorder: F11.93
- Sedative, hypnotic, or anxiolytic withdrawal, Without perceptual disturbances, Without use disorder: F13.939
- Sedative, hypnotic, or anxiolytic withdrawal, With perceptual disturbances, Without use disorder: F13.932
- Amphetamine or other stimulant withdrawal, Without use disorder: F15.93
- Other (or unknown) substance withdrawal, Without use disorder: F19.939
- Sedative, hypnotic, or anxiolytic withdrawal delirium, Without moderate or severe use disorder: F13.931
These additions are critical for accurately coding clinical presentations where individuals experience withdrawal symptoms, but do not meet the criteria for a substance use disorder. This distinction is important for clinical documentation, statistical reporting, and appropriate patient care.
Update to Factitious Disorder Coding
Another change involves the coding for factitious disorder imposed on another. The ICD-10-CM code was updated from F68.10 to F68.A, effective October 1, 2018. While seemingly a minor change in code designation, it reflects the ongoing refinement of diagnostic classifications and coding systems.
Conclusion
The inclusion of the “no diagnosis or condition” category with the ICD-10-CM code Z03.89, alongside the more detailed coding for withdrawal syndromes and updates to factitious disorder coding, represents significant improvements in the DSM-5 and ICD-10-CM interface. These changes enhance the accuracy and clinical utility of diagnostic and coding practices in mental health, ensuring a more precise representation of patient presentations and facilitating better communication and data collection within the field.
