Coding for Mental Health Screening in the Dental Practice

Coding for Mental Health Screening in the Dental Practice
Estela Vargas, CRDH

Mental health concerns for people from all walks of life are central to our world and have worsened over the last few years. Children, our future, are particularly at risk. According to Mental Health America, nationally, 1 in 10 youth covered under private insurance do not have coverage for mental or emotional difficulties – totaling over 1.2 million youth. Psychological and physical health are equally important components of overall health. For example, depression increases the risk of many physical health problems, particularly conditions like diabetes, heart disease, and stroke. Similarly, chronic conditions can increase the risk of mental illness. According to the CDC, mental illnesses are among the most common health conditions in the United States.

Here are some current statistics:

• More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.
• 1 in 5 Americans will experience a mental illness in a given year.
• 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.
• 1 in 25 Americans lives with a severe mental illness, such as schizophrenia, bipolar disorder, or major depression.

Mental health evaluations are beyond the scope of care in a dental practice. There is a high chance that the dental team will treat patients suffering from mental disorders frequently. However, many mental health disorders result in poor oral hygiene, neglected dietary needs, and physical issues that result in the prevalence of dental decay, periodontal disease, and oral and facial injuries.

When patients seek treatment for a dental condition, they go to a dentist. Many people see the dentist twice a year. When they have a psychological problem, they may seek a physician, but there is still a stigma associated with mental illness. It may be that fewer people seek mental health care than seek the dentist.

 What if your patient has a mental health crisis and is in your chair for dental treatment? Do mental health breakdowns cause dental conditions? Does the patient have depression and now doesn't practice oral hygiene in-home care? Experts have their opinions, but when you see patients in mental distress, how can you record the encounter, primarily when it is directly related to their oral health and well-being?

 

There are no CDT codes that would describe screening for mental health disorders or risk factors. The closest code combination to use would be unspecified codes, adjunctive codes, and ICD10 diagnostic codes. The problem I have with the ICD 10 codes is that dental healthcare providers are not qualified to diagnose patients with mental illnesses, but they can approximate them. Coding the encounter would then be transferred to a dental insurance claim if applicable. Whether paid or not, it is a record of care rendered to the patient.

Below, I highlighted some of the ICD10 descriptions I've personally witnessed in my clinical career. Many of them with children, teens, unstable parents, drug users, veterans that have PTSD, and many other psychological issues.

 

CDT CODES

D0191 assessment of patient-a limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment

D9912 pre-visit patient screening - Capture and documentation of a patient's health status before or on the scheduled date of service to evaluate the risk of infectious disease transmission if the patient is to be treated within the dental practice.

D9992 dental case management - care coordination - Assisting in a patient's decisions regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations, and payment systems. Record the additional time and resources provided.

D9993 dental case management - motivational interviewing Patient-centered, personalized counseling using methods such as Motivational Interviewing (MI) to identify and modify behaviors interfering with positive oral health outcomes. This is a separate service from traditional nutritional or tobacco counseling.

D9994 dental case management - patient education to improve oral health literacy 

Individual, customized communication of information to assist the patient in making appropriate health decisions. Designed to improve oral health literacy, explained in a manner acknowledging economic circumstances and different cultural beliefs, values, attitudes, traditions, and language preferences and adopting information and services to these differences, which requires the expenditure of time and resources beyond that of an oral evaluation or case presentation.

D9997 dental case management - patients with special health care needs. Special treatment considerations for patients/individuals with physical, medical, developmental, or cognitive conditions resulting in substantial functional limitations or incapacitation require that modifications be made to the delivery of treatment to provide customized or comprehensive oral health care services.

D0999 - unspecified diagnostic procedure, by report

D1321 counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use

D1320 Tobacco counseling for the control and prevention of oral disease

 

ICD10 CODES

R45.5 Hostility

R45.6 Violent behavior

R45.7 State of emotional shock and stress, unspecified

R45.8 Other symptoms and signs involving emotional state

R45.81 Low self-esteem

R45.82 Worries

R45.83 Excessive crying of child, adolescent, or adult

R45.84 Anhedonia

R45.85 Homicidal and suicidal ideations

R45.850 Homicidal ideations

R45.851 Suicidal ideations

R45.86 Emotional lability

R45.87 Impulsiveness

R45.88 Nonsuicidal self-harm

R45.89 Other symptoms and signs involving emotional state

R46. Symptoms and signs involving appearance and behavior

R46.0 Very low level of personal hygiene

R46.1 Bizarre personal appearance

R46.2 Strange and inexplicable behavior

R46.3 Overactivity

R46.4 Slowness and poor responsiveness

F05 Delirium due to known physiological condition

F41.0 Panic disorder [episodic paroxysmal anxiety]

F41.1 Generalized anxiety disorder

F41.3 Other mixed anxiety disorders

F41.8 Other specified anxiety disorders

F41.9 Anxiety disorder, unspecified

F43.0 Acute stress reaction

F44.0 Dissociative amnesia

F44.1 Dissociative fugue

F44.2 Dissociative stupor

F44.4 Conversion disorder with motor symptom or deficit

F44.5 Conversion disorder with seizures or convulsions

F44.6 Conversion disorder with sensory symptoms or deficit

F44.7 Conversion disorder with mixed symptom presentation

F44.9 Dissociative and conversion disorder, unspecified

F48.9 Nonpsychotic mental disorder, unspecified

F68.11 Factitious disorder imposed on self, with predominantly psychological signs and symptoms

F68.13 Factitious disorder imposed on self, with combined psychological and physical signs and symptoms

F68.8 Other specified disorders of adult personality and behavior

F99 Mental disorder, not otherwise specified

R44.0 Auditory hallucinations

R44.2 Other hallucinations

R44.3 Hallucinations, unspecified

R45.0 Nervousness

R45.2 Unhappiness

R45.3 Demoralization and apathy

R45.4 Irritability and anger

Z72.810 Child and adolescent antisocial behavior

Z72.811 Adult antisocial behavior

Even if we are not in the “business” of mental health, we are witnessing the effects of it every day working with patients. If we can identify mental health conditions related to dental care, we can refer our patients to the proper providers for care.

The purpose of coding with the CDT and the ICD10 is to create a viable healthcare record for the patient. We code what we do, and we code what we observe. Overall the results would be that patients receive the best care for their total health and well-being.

 

Resources:

https://www.mhanational.org/issues/state-mental-health-america

R45.89 OTHER SYMPTOMS AND SIGNS INVOLVING EMOTIONAL STATE. https://healthprovidersdata.com/hipaa/codes/ICD10-R45.89

National Mental Illness Awareness Week Facts & Treatments - We Level Up .... https://welevelup.com/news/mental-illness-awareness-week/

ADA COVID-19 Coding & Billing Guidance (Teledentistry). https://thedentalbutler.com/ada-covid-19-coding-billing-guidance-teledentistry/

F68.8 - ICD-10-CM Other specified disorders of adult personality and .... https://icd10coded.com/cm/F68.8/

FEHB : Brochure Creation Tool - OPM.gov. https://www.opm.gov/healthcare-insurance/dental-vision/plan-information/plans/BrochureJson?brochureNumber=MetLife&year=2022

2023 ICD-10-CM Diagnosis Code F44.4 - ICD10Data.com. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F40-F48/F44-/F44.4

ADA Guide To the "D9912 pre-visit patient screening" Procedure. https://www.mouthhealthy.org/~/media/ADA/Publications/Files/D9912%20-%20PreVisit%20Patient%20Screening%20Guide_2021Aug.pdf?la=en

2022 CDT code changes - Humana. https://docushare-web.apps.external.pioneer.humana.com/Marketing/docushare-app?file=4277182

Dental Insurance and Caries Management by Risk Assessment - CariFree. https://carifree.com/resources/dental-insurance-and-caries-management-by-risk-assessment/