ICD 10 Codes Mental Health Therapy Billing
Suicidal ideation ICD-10
Suicidal ideation ICD-10 is the code used to diagnosis thoughts of suicide, which is a serious public health problem. It is currently ranked the 12th leading cause of death in the United States. As an obvious precursor to suicide, the diagnosis of suicidal ideation takes on great importance. Unfortunately, accurate suicidal ideation ICD-10 coding is frequently complicated. Suicidal ideation is often subsumed under major depression and gets lost as an independent problem. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not even list suicidal ideation as a separate diagnosis. While the International Classification of Diseases, version 10 (ICD-10) does list suicidal ideation separately, it can be difficult to find. What’s more, there may be confusion as to whether—and when—it should be diagnosed. Here is what you need to know to make an accurate diagnosis of suicidal ideation.
What is Suicidal Ideation According to the International Classification of Diseases?
The most recent version of the International Classification of Diseases defines suicidal ideation as “thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans.”
Prevalence of Suicidal Ideation
In 2020, an estimated 12.2 million American adults thought about committing suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted suicide. Almost five percent of adults in the United States have reported suicidal ideation in the past year. What is maybe most concerning is that suicidal ideation is most prevalent in young people: 11.3 percent of adults aged 18-25 had suicidal thoughts.
ICD-10 Diagnosis of Suicidal Ideation: R45.851
The suicidal ideation ICD-10code is under the general R45 codes. What is an R code you may ask? The ICD defines R codes as “symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified in the ICD-10”. R45 diagnoses are symptoms and signs involving an emotional state. For suicidal ideation ICD-10, the code is R45.851.
So, what does all that mean? Suicidal ideation is looked at as a symptom rather than a full disorder. If you try to find the criteria for it you will be out of luck. But the symptom is important enough to qualify for its own diagnosis. In fact, it is billable as a stand-alone diagnosis. However, that doesn’t mean it is always a straightforward process. Diagnosing suicidal ideation and using suicidal ideation ICD-10 codes — especially for insurance purposes — presents a host of complications.
Challenges in Differential Diagnosis
The following codes present challenges in diagnosing suicidal ideation:
F32 Depressive Episode
Suicidal ideation is a symptom of a depressive episode. You don’t need to feel suicidal to be diagnosed with depression but, if you do, a depression diagnosis is frequently not far behind. Because of its association with depression, suicidal ideation is often not identified as a separate diagnosis. In reality, many practitioners will not diagnose suicidal ideation if a depressive episode is diagnosed. They believe that because suicidal ideation is already a symptom it does not warrant a separate diagnosis. Whether or not you want to diagnose suicidal ideation in addition to a depressive episode, is up to personal professional discretion.
F60.3 Borderline Personality Disorder (BPD)
Similarly, suicidal threats and self-harm are often symptoms of BPD. It is not uncommon for a client suffering from BPD to tell their therapist how they plan to kill themself. While this seems like clear-cut suicidal ideation, many clinicians would only diagnose BPD alone without a separate diagnosis. Once again, the assumption is that the suicidal ideation is subsumed within the diagnosis of the larger disorder.
T14.91 Suicide Attempt
It is common sense. You need to have experienced suicidal ideation to make a suicide attempt. But, if there is an attempt, it supersedes the diagnosis of ideation. In other words, you don’t need to diagnose suicidal ideation if there is an actual attempt. Anyone who sees that a person attempted suicide will get the point.
X and T Codes: Intentional Self-Harm
A variety of X and T codes represent different types of self-harm. For example, X78.1XXA is intentional self-harm by a knife. People self-harm for different reasons, and those reasons are not always suicide. More information is needed from the client to determine whether suicidal ideation is involved with intentional self-harm. If someone has self-harmed, it is the therapist’s job to dig a little deeper and find out if they are experiencing suicidal ideation
Z91.51 Personal History of Suicidal Behavior and Z91.52 Personal History of Non-Suicidal Self-Harm
These two codes involve a client’s history of suicidal behavior and self-harm that may complicate the diagnosis of suicidal ideation. Although they provide valuable information that can help guide a client’s treatment, they should not be confused with a client’s current mental state. Past behavior is just that, in the past. If someone is exhibiting current suicidal ideation then it needs to be diagnosed as such. Diagnoses of historical behavior are not enough to paint an accurate picture of what is going on now.
Tips for Diagnosing Suicidal Ideation
- Although it is uncommon, you can diagnose suicidal ideation without another psychiatric condition. Approximately 10 percent of individuals who commit or attempt suicide have no identifiable psychiatric illness. For example, you could have a couple of symptoms of borderline personality disorder but not meet the necessary criteria for diagnosis. If that is the case—and they are expressing suicidal ideation—it needs to be diagnosed alone.
- When assigning a diagnosis to someone, it is crucial to recognize the presenting problem. Did they enter treatment because of their suicidal ideation? If the answer is yes, then you might seriously consider making suicidal ideation the primary diagnosis, even if they have another relevant disorder.
- Earlier, it was mentioned that diagnosing suicidal ideation is often ignored when there is another related disorder. While that is true, it is a dangerous practice. Suicidal ideation can turn very dangerous very quickly. You will probably want to diagnose it no matter what other disorders the client may have. At the very least, you want to cover yourself if something goes wrong.
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The suicidal ideation ICD-10 diagnosis of is categorized as a symptom, rather than a disorder. But that doesn’t make it any less serious. And many similar and related diagnoses may confuse diagnosis.
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