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Provider Manual

Risk Adjustment - Behavioral health disorders

Last Updated on June 17, 2019

Hierarchical Condition Category Coding and Behavioral Health Disorders

There are multiple chronic behavioral health conditions that adversely affect patients and have an impact on their ability to function on a daily basis.  Many of these conditions are associated with hierarchical condition category codes. 

Some of the most commonly diagnosed conditions and details that should be included in documentation to accurately code for behavioral health disorders  include the following:

  • Depression, not further specified
  • Major depressive disorder
    • Single or recurrent episode
    • Mild, moderate or severe
    • With or without psychotic behavior
    • Partial or full remission
  • Bipolar disorder
    • Single or recurrent episode
    • Manic, depressed or mixed
    • Mild, moderate or severe
    • With or without psychotic behavior
    • Partial or full remission
  • Schizophrenia
    • Acute exacerbation
    • In remission
    • Simple, disorganized, catatonic, paranoid, residual or undifferentiated type
  • Alcohol Related Disorders
    • Specify Dependence, Use or Abuse
      • In remission
      • Associated with intoxication – uncomplicated or with delirium
      • Associated with withdrawal - uncomplicated or with delirium or perceptual disturbance
      • Associated with alcohol induced psychotic disorder with delusions or  hallucinations
      • Associated with alcohol induced delirium, anxiety, sexual dysfunction, sleep or mood disorder, or persisting amnestic disorder or dementia
  • Drug Related Disorders
Related to  - use of opioids, cannabis, sedatives, hypnotics, anxiolytic agents, cocaine, stimulants, hallucinogens, inhalants or other psychoactive substances
  • Specify Dependence, Use or Abuse in remission
    • Associated with intoxication – uncomplicated, with delirium or perceptual disturbance
    • Associated with withdrawal - uncomplicated or with delirium
    • Associated with substance induced psychotic disorder with delusions or  hallucinations
    • Associated with substance induced delirium, anxiety, sexual dysfunction, sleep or mood disorder, or persisting amnestic disorder or dementia

Questions

Brenda Anderson
Revenue Management Educator
Security Health Plan 
Telephone: 715-221-9598

Shared email:   rf.shp.risk.adjustmnt@securityhealth.org