Schizophrenia is a severe mental disorder in which people interpret reality abnormally. The condition mainly affects the whole way how people think, feel, and perceive. People with this chronic brain disorder may often find it difficult to distinguish between what is real and unreal, to think clearly, relate to others, manage emotions and function normally. The condition may lead to a combination of disordered thinking and behaviors involving auditory hallucinations (voices) and delusions (fixed false beliefs) that may impair day-to-day functioning, and can be extremely disabling. Most cases of schizophrenia appear in the late teens or early adulthood and require lifelong treatment. In rare cases, schizophrenia can even affect young children and adolescents with slightly different symptoms. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Documenting this psychiatric condition to ensure correct coding can be challenging. Outsourcing medical billing services can help healthcare providers save time and effort, and submit accurate claims for optimal reimbursement.
Reports suggest that schizophrenia affects an estimated one percent of all adult population, globally. The condition is generally classified into different types namely – paranoid, disorganized, catatonic, Undifferentiated, residual and other schizophrenia. The exact cause of this condition is unknown, but researchers claim that combinations of factors like genetic inheritance, chemical imbalance in the brain and environmental factors directly contribute to this condition. Problems with certain naturally occurring brain chemicals, (like neurotransmitters called dopamine and glutamate), may contribute to this brain disorder. If left untreated, schizophrenia can lead to severe problems or complications like – self-injury, suicidal thoughts and attempts, anxiety disorders and obsessive-compulsive disorder (OCD), health or medical conditions, alcohol or drug abuse, aggressive behavior, depression and social isolation that may in turn affect every walk of life.
Symptoms of Schizophrenia
Symptoms of schizophrenia most commonly occur between the ages of 16 and 30 years. In majority of cases, males tend to show symptoms at a slightly younger age than females. The symptoms of the condition develop so slowly that the individual does not even know that he/she had the problem even for so many years. In some rare cases, the symptoms can strike suddenly and develop quickly. Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms.
Generally, the symptoms are classified into three different categories –
- Positive symptoms – Also known as psychotic symptoms, these are psychotic behaviors not generally seen in healthy people. People may “lose touch” with some aspects of reality. Symptoms include – hallucinations, delusions, thought disorders (unusual or dysfunctional ways of thinking) and movement disorders (agitated body movements).
- Negative symptoms – This refers to reduced or lack of ability to function normally. Symptoms include – absence of facial expressions or lack of motivation, reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities and reduced speaking.
- Cognitive symptoms – These symptoms affect the person’s thought processes and include poor executive functioning (the ability to understand information and use it to make decisions), trouble focusing or paying attention and problems with working memory (the ability to use information immediately after learning it).
Other related symptoms include – social withdrawal, poor expression of emotions, lack of motivation (avolition), trouble sleeping, unawareness of illness, irritability or depressed mood and cognitive difficulties.
Diagnosing and Treating the Symptoms of Schizophrenia
As part of the diagnosis, psychiatrists and other mental health professionals may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 5th Edition), published by the American Psychiatric Association (APA). Earlier, there were different subtypes of schizophrenia, such as – paranoid schizophrenia, disorganized, or hebephrenic schizophrenia, catatonic schizophrenia, childhood schizophrenia and schizoaffective disorder. However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders changed the method of classification to bring all these categories under a single heading – “Schizophrenia”. The decision was taken to improve diagnostic stability and provide better treatment.
In order to confirm the diagnosis of this condition, patients must have at least two of the following typical symptoms like – delusions, disorganized or catatonic behavior, disorganized speech, hallucinations and negative symptoms (that are present for much of the time during the last 4 weeks). Diagnosis of schizophrenia involves a detailed analysis whether the patient has suffered any other mental health disorders and determining that the symptoms are not caused due to substance abuse, medications or other medical conditions.
Psychiatrists or other specialists may conduct a detailed psychiatric evaluation by assessing the patient’s mental state by asking questions about thoughts, moods, hallucinations, suicidal traits, violent tendencies, or potential for violence, as well as observing their demeanor and appearance. Blood tests and imaging tests such as an MRI or CT scan will be performed to rule out tumors and problems in the structure of the brain.
Schizophrenia requires life-long treatment even if the symptoms have subsided. Treatment modalities mainly consist of medications and psychosocial therapy that help better manage the condition. Anti-psychosis medications include – Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Clozapine (Clozaril) and Haloperidol. Once psychosis recedes, in addition to continuing the medications, psychological and social (psychosocial) interventions are incorporated as part of the treatment. These psychological interventions include – individual therapy, social skills training, family therapy and vocational rehabilitation. In severe cases, if patients do not respond to medications, Electroconvulsive therapy (ECT) may be considered. ECT may be helpful for patients who have extreme signs of depression.
When documenting schizophrenia, psychiatrists and other mental health specialists must include the associated symptoms, diagnosis screening tests and treatment procedures performed using the correct medical codes. For correct coding, documentation should identify whether the patient’s schizophrenia is chronic or an acute exacerbation. Medical billing outsourcing services provided by reputable medical billing companies can help physicians use the correct codes for their billing purposes.
- F20 – Schizophrenia
- F20.0 – Paranoid schizophrenia
- F20.1 – Disorganized schizophrenia
- F20.2 – Catatonic schizophrenia
- F20.3 – Undifferentiated schizophrenia
- F20.5 – Residual schizophrenia
- F20.8 – Other schizophrenia
- F20.81 – Schizophreniform disorder
- F20.89 – Other schizophrenia
- F20.9 – Schizophrenia, unspecified
- F22 – Delusional disorders
- F23 – Brief psychotic disorder
- F24 – Shared psychotic disorder
- F25 – Schizoaffective disorders
- F25.0 – Schizoaffective disorder, bipolar type
- F25.1 – Schizoaffective disorder, depressive type
- F25.8 – Other schizoaffective disorders
- F25.9 – Schizoaffective disorder, unspecified
- F28 – Other psychotic disorder not due to a substance or known physiological condition
- F29 – Unspecified psychosis not due to a substance or known physiological condition
CPT Codes for Psychology Services
- 90791 – Psychiatric diagnostic evaluation without medical services (intake interview)
- 90792 – Psychiatric diagnostic evaluation with medical services
- 90832 – Psychotherapy, 30 minutes with patient, (when performed with an E&M service: 90833), Non-facility: 64.84/Facility: 64
- 90834 – Psychotherapy, 45 minutes with patient (when performed with an E&M service: 90836) Non-facility: 85.97/Facility: 85.62
- 90837 – Psychotherapy, 60 minutes with patient (when performed with an E&M service: 90838) Non-facility: 128.6/Facility: 127.89
- 90846 – Family psychotherapy (without the patient present), 50 minutes
- 90847 – Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
- 90849 – Multiple-family group psychotherapy
- 90853 – Group psychotherapy (other than of a multiple-family group)
- 90870 – Electroconvulsive therapy (includes necessary monitoring)
People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Family support is very important for the health and well-being of people living with schizophrenia. People with this chronic condition often lack awareness that their difficulties stem from a mental disorder that requires serious attention. Therefore, it is important for family members and other mental health professionals to be well informed about the illness and need to extend adequate help and support to the patients in all situations.
Medical billing and coding for chronic mental disorders requires a clear understanding about the highly specific ICD-10 and CPT codes. Physicians can rely on the services of a reliable medical billing and coding company to submit claims for optimal reimbursement.