Factitious disorder: You may have heard this term under another name (Munchausen syndrome), and it’s one you’ll definitely need to know for the new ICD-10-CM mental health codes taking effect October 1, 2018. Out of the 55 added and revised psychiatry codes, six are devoted to factitious disorder—and they represent a significant change in documenting this disorder.
It’s more important than ever to your practice’s bottom line that you understand the nuances of each ICD-10-CM code, both the ones you’ve been using for years and those that are getting an update, says independent healthcare consultant Dorothy Steed in her live webinar with ProfEdOnDemand. During her presentation on ICD-10 updates for mental and behavioral health, Steed explains how to tell the patient’s full story with your coding and survive payers’ increased scrutiny of patient records prior to approving claims.
Factitious Disorder: On Self or Other?
The coming changes to ICD-10 code set F68 include an additional code (F68.A) for “factitious disorder imposed on another”—a condition previously known as Munchausen by proxy. This is a significant update because the five revised codes for the disorder now include the phrase “imposed on self,” thus differentiating the two different ways this disorder presents itself—and the way you’ll code it.
Perhaps the most recent and prominent example of factitious disorder is the case of Gypsy Rose Blanchard, the Missouri woman convicted of the murder of her mother after years of being subjected to a wheelchair and unnecessary treatments for illnesses Blanchard never had. Blanchard’s mother is said to have suffered from “factitious disorder imposed on another,” where an individual—often a parent—claims another person has a certain illness, invents or causes symptoms to prove this illness, and seeks treatment for the other person. Often these individuals are seeking attention and/or sympathy for themselves.
Factitious disorder imposed on self exhibits the same behaviors, with the same desire for sympathy and/or attention. This time, however, the person is faking their own symptoms – for example, pricking their own finger to include blood in a urine sample, which would naturally cause concern and further testing, or injecting bacteria under the skin to produce abscess or fever.
Like diagnosing many mental illnesses, diagnosing factitious disorder can be tricky. It can be difficult to tell when certain symptoms, such as stomach pains, are real or invented. To add to the confusion, many suffering from factitious disorder, whether imposed on self or another, may not know why they are misrepresenting facts. They often have a history of other mental illnesses and abuse.
Despite the difficulties in diagnosis, psychiatrists and others will look for certain warning signs, which include:
- A medical history that is dramatic and inconsistent
- Improvements in a condition are typically followed by relapses (since recovery would mean no more attention or sympathy)
- An eagerness on the part of a patient or proxy to pursue medical procedures, especially those that are risky
- An unwillingness to allow friends, family or others to discuss symptoms or treatment with the current physician
- A tendency to visit different hospitals or clinics in different areas
Rule Everything Else Out: Typically, physicians will perform a mental health interview first to determine if the patient’s supposed illness is real or not. If there is no evidence to support the patient’s or proxy’s claims, the patient or proxy may then be diagnosed with factitious disorder.
3 Clues to Picking the Right F68 Code
To properly code the patient’s illness, look in the documentation for:
- how the physician(s) evaluated the patient’s claims,
- the type of symptoms manifested, and
- whether or not the patient’s claims check out.
The new code F68.A addresses “factitious disorder imposed on another”: Use this for cases such as that of Blanchard mentioned above.
Code series F68.1 addresses “factitious disorder imposed on self”:
- 10: unspecified
- 11: mostly psychological signs and symptoms
- 12: mostly physical signs and symptoms
- 13: combined physical and psychological symptoms
Use Unspecified with Caution: Remember there’s no more grace period for “unspecified” codes, which can be frustrating when you have to use them due to insufficient evidence in the medical record for a more specific code. Before coding for F68.10, try to contact the diagnosing physician if you’re in doubt. If you have to go with this code, just proceed with caution, as it may result in a disgruntled payer.
Psychiatry’s 55 code adjustments for 2019 means there are a lot of new details for you to make sense of. But it is possible, says Steed, to help your medical practice get the reimbursement it deserves—every time—by getting the tools you need now, well before the changes take effect on October 1, 2018.
