Understanding Psychosis: Symptoms, Coding, and Treatment

Psychosis involves a significant disconnect from reality characterized by delusions, hallucinations, and disorganized thinking, coded as F29 in clinical systems, and responds effectively to evidence-based therapeutic interventions like cognitive behavioral therapy provided by licensed mental health professionals.

Ever wondered what happens when reality feels unclear or overwhelming? Psychosis affects more Americans than you might expect, but understanding its symptoms, causes, and therapeutic approaches can provide hope and clarity for recovery.

Understanding Mental Health Diagnoses: Unspecified Psychosis and Clinical Coding

Psychosis can be defined as a mental state characterized by a significant disconnect from reality, often triggered by conditions like schizophrenia or bipolar disorder. Symptoms may include delusions, hallucinations, scattered thoughts, and unusual behavior. Psychosis can be annotated with the code F29, according to the International Classification of Diseases, 10th Revision (ICD-10). The ICD-10 and its new revision, the ICD-11, can help in consistent and accurate labeling and communication between those in the healthcare industry. Individuals who have experienced unspecified psychosis may benefit from working with licensed clinical social workers and other mental health professionals to manage their symptoms.

What is clinical coding?

Clinical codes can be thought of as standardized alphanumeric keys used to categorize healthcare diagnoses, procedures, services, and equipment. In general, clinical codes exist to establish a consistent language system in the healthcare industry, ensuring accurate communication between healthcare providers, insurance companies, and other entities involved in patient care and billing.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), can be another tool for clinical coding, providing diagnostic criteria and terminology for mental health disorders. The DSM-5 can enable consistency and reliable diagnostic procedures, establishing a shared form of communication among patients, clinicians, and insurance providers for a more streamlined process. Clinical codes are typically based on criteria outlined in the DSM-5 and the International Classification of Diseases, 11th Revision (ICD-11, which replaced the ICD-10), ensuring universality and effectiveness in healthcare documentation and reimbursement processes.

What is unspecified psychosis?

Psychosis is typically classified as a mental state involving a disconnect from reality. While psychosis often stems from psychotic disorders like schizophrenia, a number of environmental and physiological factors may trigger psychotic symptoms. However, “unspecified psychosis” generally refers to symptoms of psychosis that are not attributable to a substance or known physiological condition. Sometimes, individuals are given the classification of unspecified psychosis when more time or information is needed to determine a specific diagnosis.

Common symptoms of psychosis

Common symptoms of psychosis can include the following:

• Delusions: Strongly held false beliefs that are not based in reality
• Hallucinations: Sensory perceptions of nonexistent stimuli, like sights and sounds that others do not perceive
• Disorganized thinking and speech: Difficulty organizing thoughts and expressing them coherently
• Disorganized behavior: Acting in a way that’s unpredictable or seemingly without purpose
• Difficulty concentrating: Finding it hard to pay attention or stay on task
• Social isolation and withdrawal: Pulling away from friends, family, and social situations
• Lack of emotional expression: Reduced or absent display of emotions, known as flat affect
• Paranoia: Extreme distrust or suspicion of others, often accompanying unfounded beliefs of persecution

Aside from psychotic disorders, a host of other ailments may cause psychosis:

• Medication- or substance-induced psychosis
• Medical ailments like brain tumors and stroke
• Bipolar disorder or depression with psychotic features
• Alzheimer’s disease
• Thyroid issues
• Lupus
• Postpartum psychosis
• Vitamin deficiencies
• High stress levels
• Trauma
• Severe head injuries

What is the ICD-10?

The International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic coding system endorsed by the World Health Organization (WHO). The ICD-10 is often used for organizing healthcare information and defining clinical codes. Although the ICD-10 was officially replaced with the ICD-11 after it was adopted in 2019 and went into effect in 2022, some practitioners may continue to use the ICD-10.

The ICD-10 and other revisions of the ICD generally define diseases, disorders, injuries, and medical procedures and translate them into standardized alphanumeric codes. This system can ensure healthcare professionals have a consistent and accurate way to record and communicate information about patient conditions, treatments, and medical services. The ICD-10 can facilitate data exchange, enhance patient care, and support medical research and public health initiatives on a worldwide scale.

The ICD-10 code for psychosis

In the ICD-10-CM (clinical modification) coding system, the code F29 is designated for the diagnosis of psychosis. This code specifically refers to unspecified psychosis that is not attributable to a substance or known physiological condition. The DSM-5 includes additional criteria detailing updates to aspects of clinical coding for psychosis:

1. Unspecified Schizophrenia Spectrum and Other Psychotic Disorders: This category normally applies to presentations in which symptoms characteristic of schizophrenia spectrum disorders cause clinically significant distress or impairment but fail to meet the criteria for any of the conditions in the schizophrenia spectrum and other psychotic disorders class.

The Unspecified Schizophrenia Spectrum and Other Psychotic Disorders category can be utilized when the healthcare professional chooses not to explain the reason that the presentation does not meet the criteria for any specific schizophrenia spectrum or psychotic disorder. It may also refer to psychosis manifestations in which there is insufficient information to make a more specific diagnosis (e.g., emergency room settings).

2. Other Specified Schizophrenia Spectrum and Other Psychotic Disorders: This category usually applies to presentations in which symptoms characteristic of schizophrenia spectrum disorders cause clinically significant distress or impairment in social, occupational, or other important areas of function, but do not meet the full criteria for any of the disorders in the Schizophrenia Spectrum and Other Psychotic Disorders class.

The Other Specified Schizophrenia Spectrum and Other Psychotic Disorders category can be used when the clinician communicates the reason the presentation fails to meet the criteria for a specific disorder. This can be done by recording “other specified schizophrenia spectrum and other psychotic disorder” followed by the specific reason (e.g., persistent visual hallucinations).

Seeking professional support

Whether you’ve experienced psychosis or are living with other mental health concerns, seeking professional insight and guidance can empower you to improve your mental health and overall well-being. For some forms of psychosis, like those triggered by long-term mental health conditions, such as schizophrenia or bipolar disorder, treatment may involve pharmacotherapy, including antipsychotics or other types of medication. It’s important to note that medications can only be prescribed by physicians or psychiatrists, not by licensed clinical social workers.

Non-pharmacological treatments like cognitive behavioral therapy (CBT) are often recommended as well. CBT generally focuses on the relationships between your thoughts, feelings, and behavior. CBT can help you recognize unhealthy or harmful thought patterns and replace them with more constructive ones, thus positively impacting your emotions and behavior.

In some cases, in-person therapy may be less convenient or difficult to attend due to barriers such as cost and local availability. Exploring telehealth therapy options like those offered by ReachLink can provide affordability and flexibility for those who have experienced psychotic episodes. The option to choose between video, phone call, and online chat for sessions can help individuals personalize the therapy process to their comfort level.

Acute psychosis may be a medical emergency requiring in-person care. However, while telehealth therapy may not be appropriate for acute psychosis, studies indicate that online CBT can be effective in addressing associated mental health conditions like anxiety and depression. CBT may also be beneficial for those who have recently experienced a psychotic episode and require support in the aftermath.

At ReachLink, licensed clinical social workers are equipped to provide therapeutic support for individuals recovering from psychosis or managing ongoing symptoms. While our providers cannot prescribe medications, they can work collaboratively with psychiatrists and primary care physicians who manage the medication aspect of treatment. This integrated approach ensures comprehensive care addressing both the psychological and physiological aspects of psychosis.

Takeaway

Healthcare professionals frequently rely on clinical codes, such as the ICD-10, to establish a streamlined mode of communication regarding patient information. These codes, such as the F29 code for unspecified psychosis, can ensure accurate and consistent communication between healthcare professionals, insurance providers, and patients. Individuals who have experienced psychosis or other mental health challenges may benefit from reaching out to a licensed clinical social worker through telehealth platforms like ReachLink, which offers accessible, evidence-based therapeutic support while coordinating with other healthcare providers for comprehensive treatment.