ICD-10-CM F24: Shared Psychotic Disorder Code
ICD-10-CM code F24 represents Shared Psychotic Disorder, a condition where an individual adopts delusions from another person with a psychotic disorder. Clinicians should document the relationship dynamics, the nature of shared delusions, and any distress or dysfunction caused by the disorder in both individuals. Detailed accounts of psychological evaluations, including the temporal relationship between the delusions of both parties, are crucial for accurate coding and potential auditing considerations.
Overview
Shared psychotic disorder, also known as folie à deux, is a rare psychiatric syndrome where a delusional belief is shared between two or more individuals, typically involving a dominant partner who has a primary psychotic disorder, such as schizophrenia, and a submissive partner who adopts the delusional beliefs of the dominant individual. The condition often arises in close relationships, such as between family members or partners, and can manifest in various forms, including shared delusions of persecution, grandeur, or other themes. Diagnosis requires careful clinical assessment to differentiate it from other psychotic disorders, particularly those within the schizophrenia spectrum. Treatment typically involves separating the individuals involved, providing antipsychotic medications to the dominant partner, and offering supportive therapy to both parties. Functional assessment is crucial, as the impact of shared delusions can significantly impair social and occupational functioning. The prognosis varies, with some individuals recovering fully after separation, while others may continue to experience psychotic symptoms.
Coding Complexity
Rating: Medium
Factors:
- Differentiating between shared psychotic disorder and primary psychotic disorders.
- Understanding the dynamics of the relationship between the individuals involved.
- Documenting the clinical assessment and treatment plan accurately.
- Navigating the nuances of antipsychotic medication management.
- Assessing functional impairment and its impact on treatment.
Comparison:
Compared to related codes such as F20 (Schizophrenia) and F22 (Persistent delusional disorders), F24 is less commonly encountered, which can lead to confusion in coding. The complexity arises from the need to establish the relationship between individuals and the shared nature of the delusions, whereas schizophrenia and persistent delusional disorders are more straightforward in terms of diagnosis and treatment.
Audit Risk Factors:
- Inadequate documentation of the relationship between individuals.
- Failure to document the primary psychotic disorder of the dominant partner.
- Lack of clarity in the treatment plan and follow-up.
- Misclassification of the disorder as a primary psychotic disorder.
- Insufficient functional assessment documentation.
Specialty Focus
- Specialty: Psychiatry
Documentation Requirements: Comprehensive psychiatric evaluation, including history of present illness, mental status examination, and functional assessment.
Common Clinical Scenarios: Evaluating a couple presenting with shared delusions, assessing family dynamics in a clinical setting.
Special Considerations: Understanding the impact of the relationship on the presentation of symptoms and treatment adherence. - Specialty: Family Medicine
Documentation Requirements: Detailed history taking, including psychosocial factors and family history.
Common Clinical Scenarios: Identifying shared psychotic disorder in a family setting during routine check-ups.
Special Considerations: Recognizing the signs of shared delusions in patients and their family members.
Coding Guidelines
According to the ICD-10 coding guidelines, F24 should be used when the delusions are shared between individuals and not attributable to a primary psychotic disorder in the submissive partner. Exclusion criteria include cases where the submissive partner has an independent psychotic disorder.
Related CPT Codes
- Code: 90837
Procedure Name: Psychotherapy, 60 minutes with patient
Clinical Scenario: Used for therapy sessions with individuals experiencing shared psychotic disorder.
Documentation Requirements: Document the duration of the session and the focus on delusional beliefs.
Specialty Considerations: Psychiatrists should note the dynamics of the relationship in therapy.
Billing Information
Billing for shared psychotic disorder requires detailed documentation of the clinical assessment, treatment plan, and follow-up care, ensuring that the relationship dynamics are clearly articulated.
Related CPT Codes
Helpful links for mental health billing and documentation
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Q: What are the key documentation elements for F24?
To ensure proper documentation for ICD-10-CM F24, clinicians should include detailed descriptions of the shared delusions, including their content and duration. It is vital to document the relationship between the individuals involved and any changes in their mental state. Documentation should also address how these delusions impact daily functioning and any treatments provided to prevent the development or transfer of delusional content. Clear differential diagnoses excluding other psychotic disorders, with thorough historical and psychological assessments, strengthen the medical record and support coding accuracy.
Q: What are common audit considerations for coding F24?
Auditors examine if the documentation clearly demonstrates that the disorder stems from the influence of another person's delusions. Misclassification as a primary psychotic disorder instead of a shared psychotic disorder may lead to coding discrepancies. Consistency in the narrative explaining interactions between the involved parties is essential. Documentation should also address any previous psychiatric conditions that could influence the current presentation. Ensuring these elements are explicit helps protect against potential audits and coding errors.
Q: How does coding F24 differ from other psychotic disorders?
Unlike primary psychotic disorders, F24 involves adopting delusions from another person who is often a close associate. It requires a dual assessment—the adopter and the source. Diagnostic criteria focus not only on the presence of delusions but also on the inter-personal relationship dynamics and the influence exerted by the source individual. This necessitates additional background on the relationships and any potential coerced, mimicked, or induced beliefs, differentiating it from independent psychotic phenomena.
Q: Are there any specialty-specific documentation needs?
Psychiatrists and psychologists must offer a detailed account of psychiatric assessments, emphasizing the influence dynamics between the afflicted parties. If interventions such as counseling are deployed, their scope and goals should be clear. For primary care providers, coordination with specialists should be evident in records, covering all medical treatments and any mental health referrals, thus ensuring a comprehensive care approach is documented.
Q: What coding complexities are associated with F24?
Coding complexities for F24 arise due to the dual or even multiple individuals involved. Clear documentation distinguishing shared psychotic disorder from co-existing or independent psychotic disorders (such as schizophrenia or delusional disorder) can aid in avoiding coding errors. Additionally, the intertwined nature of symptoms between the involved parties may lead to challenging differential diagnosis and coding audits. It's essential to document any overlap or distinct symptoms meticulously.