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Mental Health – This question came in and took me a few minutes to figure out exactly what they were asking, but once I did a little research I got where this person was coming from.

Q: I am trying to verify exactly what V71.09 means – (mind you, this is not ICD-10, this is ICD-9) – or get more specific meaning behind the description. I show two different definitions: V71.09 No Diagnosis on Axis II, V71.09 No Diagnosis or Condition on Axis I.

A: When you go look up in your tabular V71.09 states that it’s other suspected mental condition. Let’s get some background and that will tell us, I believe what we need to know.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) – You’re going to go and we’re going to be working with DSM from this point on. The axis is referring to how they determine what’s wrong with their patient. Again, this is for mental health.

Mental Health Medical Coding – Video

Axis I refers broadly to the principal disorder

Axis II lists any personality disorder that may be shaping the current response to the Axis I problem

Axis III lists any medical or neurological problems that may be relevant to the individual’s current or past psychiatric problems;

Axis IV codes the major psychosocial stressors to the individual has faced recently

Axis V codes the “level of function”

This is all based on mental health. So, if we’re going to see a breakdown of that, we have to think “other suspected mental condition,” but there’s no diagnosis. With this particular scenario we have, here is the impression: Axis I: No diagnosis, Axis II: No diagnosis, Axis III: None, Axis IV: Educational problems and Axis V: GAF=85.

Let’s go look at this other one: Axis I: No diagnosis. It’s not saying that they don’t have diagnosis per se, it’s other suspected mental condition with no diagnosis is what they’re saying.   Axis II: Borderline intellectual functioning, Axis III: Fetal alcohol syndrome by history (they know that), Axis IV: Occupational and educational problems, and Axis V: GAF=75.

What that is telling you is that this right here is on Axis II, which is any personality disorder that may be shaping the current response to the Axis I problem, the diagnosis you’re going to be able to state – wait, I don’t want to say the wrong thing – other suspected mental condition.

Then, if the person has Axis I, same thing: refers broadly to the principal disorder. It doesn’t mean that Axis I is not part of the diagnosis code, what it means is that they’re using the V71.09, because in Axis I for the principal disorder there is: other suspected mental condition. But they don’t have a diagnosis for you.

Same thing with II: personality disorder that may be shaping the current response to the Axis I – again, other suspected mental condition. OK? So they don’t have a diagnosis yet so they gave him V71.09.

I hope that helps you. Mental health is not something that I’m most familiar with, but as the tide is starting to change and we’re seeing that there is more need for mental health in our society, then I think we’re going to see some more specialties in this for coding. So, it’s a good thing to get familiar with it.

More Related Details about Mental Health Medical Coding

2013 Psychiatric CPT Coding Changes

AAPC – Behavioral Health

mental health medical coding

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2016-11-20T23:37:29+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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