Bipolar DisorderBiploar disorder or manic-depressive disorder is a major mood disorder in which the person mostly experiences episodes of depression and episodes of mania. In other words, it is a disorienting condition that results in extreme shifts in mood. The person may feel like he/she is on top of the world at one time and fall into a relentless depression after some time, say a few weeks. This condition has a high potential for adverse consequences, especially a risk for suicide. Thus, it is critical to obtain treatment for this condition at the right time.

When it comes to reporting this condition, the ICD-10 medical coding system provides more specific codes to reflect the patient’s condition more accurately. The following information is for review by practices and medical billing companies.

  • F31: Bipolar disorder
  • F31.0: Bipolar disorder, current episode hypomanic
  • F31.1: Bipolar disorder, current episode manic without psychotic features
  • F31.10: Bipolar disorder, current episode manic without psychotic features, unspecified
  • F31.11: Bipolar disorder, current episode manic without psychotic features, mild
  • F31.12: Bipolar disorder, current episode manic without psychotic features, moderate
  • F31.13: Bipolar disorder, current episode manic without psychotic features, severe
  • F31.2: Bipolar disorder, current episode manic severe with psychotic features
  • F31.3: Bipolar disorder, current episode depressed, mild or moderate severity
  • F31.30: Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
  • F31.31: Bipolar disorder, current episode depressed, mild
  • F31.32: Bipolar disorder, current episode depressed, moderate
  • F31.4: Bipolar disorder, current episode depressed, severe, without psychotic features
  • F31.5: Bipolar disorder, current episode depressed, severe, with psychotic features
  • F31.6: Bipolar disorder, current episode mixed
  • F31.60: Bipolar disorder, current episode mixed, unspecified
  • F31.61: Bipolar disorder, current episode mixed, mild
  • F31.62: Bipolar disorder, current episode mixed, moderate
  • F31.63: Bipolar disorder, current episode mixed, severe, without psychotic features
  • F31.64: Bipolar disorder, current episode mixed, severe, with psychotic features
  • F31.7: Bipolar disorder, currently in remission
  • F31.70: Bipolar disorder, currently in remission, most recent episode unspecified
  • F31.71: Bipolar disorder, in partial remission, most recent episode hypomanic
  • F31.72: Bipolar disorder, in full remission, most recent episode hypomanic
  • F31.73: Bipolar disorder, in partial remission, most recent episode manic
  • F31.74: Bipolar disorder, in full remission, most recent episode manic
  • F31.75: Bipolar disorder, in partial remission, most recent episode depressed
  • F31.76: Bipolar disorder, in full remission, most recent episode depressed
  • F31.77: Bipolar disorder, in partial remission, most recent episode mixed
  • F31.78: Bipolar disorder, in full remission, most recent episode mixed
  • F31.8: Other bipolar disorders
  • F31.81: Bipolar II disorder
  • F31.89: Other bipolar disorder
  • F31.9: Bipolar disorder, unspecified

In the case of an individual with bipolar disorder, there is a high risk of relapse for about six months after remission from an acute episode of mania or depression. Therefore, you should not only focus on treating the current symptoms, but also take steps to prevent future episodes. This is why, continuation and maintenance of therapy is recommended as a treatment for bipolar disorder. Once it is possible to stabilize the moods of a manic or depressive episode, drug therapy can be continued, often at lower doses.

Standard maintenance treatment includes pharmacotherapy plus adjunctive psychotherapy. Still, pharmacotherapy alone is reasonable when psychotherapy is not available or is declined. However, each specific form of therapy has its own strengths and limitations and the physician should be aware of unique efficacy and side effects as well as consider treatment components, goals, and individual patient characteristics when selecting a long-term maintenance therapy for the patient.

New Study on Maintenance Treatment with Lithium

Many patients with bipolar disorder take lifelong lithium as maintenance therapy to prevent relapse. Lithium is a simple salt that acts on the central nervous system of the patient and stabilizes the mood so that he/she can have more control over their emotions and cope up with their mood disorders better. Studies have also revealed that lithium significantly reduces the risk of suicide in these patients and prevents future manic episodes. However, a new study published in JAMA Psychiatry says that long-term maintenance treatment with lithium may increase the risk of chronic kidney disease (CKD).

The researchers conducted a nationwide population-based study and compared rates of CKD, in particular rates of end-stage CKD, among the patients who took lithium, anticonvulsants, or other drugs used for bipolar disorder treatment. The participants in the study were divided into two cohorts – Cohort 1 comprised patients with a diagnosis of a single manic episode or bipolar disorder between January 1, 1994 and December 31, 2012 and exposed to either lithium or anticonvulsants, while Cohort 2 comprised patients diagnosed as having bipolar disorder.

According to the total sample and not considering diagnoses, long-term use of lithium was associated with an increased rate of definite CKD and possible CKD while the use of anticonvulsants, antipsychotics, or antidepressants was not associated with CKD. The use of lithium or any of the other drugs was not associated with the increasing rates of end-stage CKD.

In patients diagnosed with bipolar disorder, the use of lithium and anticonvulsants was associated with an increased rate of definite CKD and possible CKD. The use of antipsychotics or antidepressants was not associated with CKD.

Again, the use of lithium was not associated with the increasing rates of end-stage CKD in bipolar disorder patients. However, the use of anticonvulsants was associated with end-stage CKD.