Psychotic Disorder Due to Another Medical Condition/Cataonia - Catatonia Associa

Psychotic Disorder Due to Another Medical Condition

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A. Prominent hallucinations or delusions.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder.

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

 

Code based on predominant symptom:

293.81 (F06.2) With delusions: If delusions are the predominant symptom.

293.82 (F06.0) With hallucinations: If hallucinations are the predominant symptom.

Coding note: Include the name of the other medical condition in the name of the mental disorder (e.g., 293.81 [F06.2] psychotic disorder due to malignant lung neoplasm, with delusions).

The other medical condition should be coded and listed separately immediately before the psychotic disorder due to the medical condition (e.g., 162.9[C34.90] malignant lung neoplasm; 293.81 [F06.2] psychotic disorder due to malignant lung neoplasm, with delusions).

Specify current severity:

Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms.

Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter "Assessment Measures" in Section III of DSM-5.)

Note: Diagnosis of psychotic disorder due to another medical condition can be made without using this severity specifier.

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Catatonia

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Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

293.89 (F06.1)

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A. The clinical picture is dominated by three (or more) of the following symptoms:
1. Stupor (i.e., no psychomotor activity; not actively relating to environment).

2. Catalepsy (i.e., passive induction of a posture held against gravity).

3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).

4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).

5. Negativism (i.e., opposition or no response to instructions or external stimuli).

6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).

7. Mannerism (i.e., odd, circumstantial caricature of normal actions).

8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal- directed movements).

9. Agitation, not influenced by external stimuli.

10. Grimacing.
11. Echolalia (i.e., mimicking another's speech).

12. Echopraxia (i.e., mimicking another's movements).

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Coding note: Indicate the name of the associated mental disorder when recording the name of the condition (e.g., 293.89 [F06.1] catatonia associated with major depressive disorder).

Code first the associated mental disorder (i.e., neurodevelopmental disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, or other mental disorder) (e.g., 295.70 [F25.1] schizoaffective disorder,
depressive type; 293.89 [F06.1] catatonia associated with schizoaffective disorder).

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Catatonic Disorder Due to Another Medical Condition

293.89 (F06.1)

 

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A. The clinical picture is dominated by three (or more) of the following symptoms:

1. Stupor (i.e., no psychomotor activity; not actively relating to environment).

2. Catalepsy (i.e., passive induction of a posture held against gravity).

3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).

4. Mutism (i.e.,no or very little, verbal response [Note: not applicable if there is an established aphasia]).

5. Negativism (i,e., opposition or no responce to instructions or extemalsyimuli).

6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).

7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]).

Negativism (i.e., opposition or no response to instructions or external stimuli).

8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal directed movements).

9. Agitation, not influenced by external stimuli.

10. Grimacing.

11. Echolalia (i.e., mimicking another's speech).

12. Echopraxia (i.e., mimicking another's movements).

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder (e.g., a manic episode).

D.The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Coding note: Include the name of the medical condition in the name of the mental disorder (e.g., 293.89 [F06.1]) catatonic disorder due to hepatic encephalopathy).

The other medical condition should be coded and listed separately immediately before the catatonic disorder due to the medical condition (e.g., 572.2 [K71.90] hepatic encephalopathy; 293.89 [F06.1] catatonic disorder due to hepatic encephalopathy).
 

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Unspecified Catatonia

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This category applies to presentations in which symptoms characteristic of catatonia cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but either the nature of the underlying mental disorder or other medical condition is unclear, full criteria for catatonia are not met, or there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).
 
Coding note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems, followed by 293.89 (F06.1) unspecified catatonia.

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Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

298.8 (F28)

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This category applies to presentations in which symptoms characteristic of a schizophrenia spectrum and other psychotic disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the schizophrenia spectrum and other psychotic disorders diagnostic class.

The other specified schizophrenia spectrum and other psychotic disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific schizophrenia spectrum and other psychotic disorder. This is done by recording "other specified schizophrenia spectrum and other psychotic disorder" followed by the specific reason (e.g., "persistent auditory hallucinations").
Examples of presentations that can be specified using the "other specified" designation include the following:


1. Persistent auditory hallucinations occurring in the absence of any other features.

2. Delusions with significant overlapping mood episodes: This includes persistent delusions with periods of overlapping mood episodes that are present for a substantial portion of the delusional disturbance (such that the criterion stipulating only brief mood disturbance in delusional disorder is not met).

3. Attenuated psychosis syndrome: This syndrome is characterized by psychotic-like symptoms that are below a threshold for full psychosis (e.g., the symptoms are less severe and more transient, and insight is relatively maintained).

4. Delusional symptoms in partner of individual with delusional disorder: In the context of a relationship, the delusional material from the dominant partner provides content for delusional belief by the individual who may not otherwise entirely meet criteria for delusional disorder.

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Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
298.9 (F29)

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This category applies to presentations in which symptoms characteristic of a schizophrenia spectrum and other psychotic disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the schizophrenia spectrum and other psychotic disorders diagnostic class.

The unspecified schizophrenia spectrum and other psychotic disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific schizophrenia spectrum and other psychotic disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

 

 
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