That frustrating moment when your patient clearly presents with bipolar disorder symptoms- cycling between depressive episodes and periods of elevated mood, but selecting the correct ICD-10 code feels like navigating a labyrinth. Trust me, we have all been there!
Many therapists struggle with translating clear clinical presentations into the precise language of diagnostic coding.
This cheat sheet breaks down everything you need to know about bipolar ICD-10 codes for efficient documentation and accurate billing.
Introduction to Bipolar Affective Disorder
Bipolar affective disorder, commonly known as bipolar disorder, is a complex mental illness that significantly impacts a person’s mood, energy levels, and daily functioning.
Characterized by extreme mood swings, and manic depression, it includes periods of manic highs and depressive lows. These mood episodes can vary in intensity and duration, and the disorder itself can be classified into several types, including bipolar I disorder, bipolar II disorder, and cyclothymic disorder.
In clinical practice, the current episode of bipolar disorder can be identified as manic, depressive, or mixed, and further specified by its severity—mild, moderate, or severe.
The ICD-10 code F31 is used to classify bipolar disorder, providing a standardized framework for diagnosis and treatment.
Essential Bipolar ICD-10 Code Framework
F31: Bipolar Affective Disorder (Manic Depressive Psychosis)
The F31 code series represents the core bipolar disorder current episode classifications:
- F31.0: Bipolar disorder, current episode hypomanic
- Elevated mood and increased energy without severe functional impairment
- No psychotic features
- F31.1: Bipolar disorder current episode manic without psychotic symptoms
- Elevated mood with significant functional impairment
- No hallucinations or delusions
- Episode manic without psychotic features
- F31.2: Bipolar disorder current episode manic severe with psychotic symptoms
- Manic episode with delusions or hallucinations
- Severe with psychotic features
- Often presents with grandiose delusions
- F31.3: Bipolar disorder, current episode depressed mild or moderate severity
- Current episode includes mild or moderate depressive symptoms
- History of at least one hypomanic, manic, or mixed episode
- F31.4: Bipolar disorder, current episode depressed severe without psychotic symptoms
- Major depression with bipolar history
- Severe without psychotic features
- F31.5: Bipolar disorder, current episode depressed severe with psychotic symptoms
- Severe depressive episode with psychotic features
- May include depressive psychosis symptoms
- F31.6: Bipolar disorder, current episode mixed
- Rapid alternation or mixture of manic and depressive symptoms
- Disorder current episode mixed presentation
- F31.7: Bipolar disorder, currently in remission
- History of confirmed bipolar disorder
- Currently in partial remission or full remission
- Use when disorder currently in remission
- F31.8: Other bipolar affective disorders
- Includes bipolar II disorder
- Recurrent hypomanic episodes without major depressive episodes
- F31.9: Bipolar disorder unspecified
- Use when specific episode type cannot be determined
- Temporary code while gathering more clinical data
F30: Single Manic Episode
For initial presentations without established pattern:
- F30.0: Hypomania
- First hypomanic episode
- No previous mood disturbance history
- F30.1: Manic episode without psychotic symptoms
- First presentation of mania
- Single manic episode without psychotic symptoms
- F30.2: Manic episode with psychotic symptoms
- First manic episode with psychotic features
- Single manic episode with delusions or hallucinations
- F30.8-F30.9: Other and unspecified manic episodes
- Used for atypical presentations
Related Diagnostic Codes
- F25.0: Schizoaffective disorder, bipolar type
- Both schizophrenic and manic symptoms
- Psychotic symptoms persist during euthymic periods
- F34.0: Cyclothymia
- Persistent mood instability below threshold for bipolar
- Multiple hypomanic episodes and periods of mild depression
- Cyclothymia is a mood disorder characterized by numerous periods of depression and mild elation, which is not severe enough to be classified as bipolar disorder.
- F32/F33: Major depressive disorder (single episode or recurrent)
- When differentiating from bipolar depression
Critical Assessment Elements for Accurate Coding
Episode Characterization
Document these key elements:
- Current episode type (manic, depressive, mixed, or in remission)
- Severity (mild, moderate, or severe, including episode severe with psychotic symptoms, and episode severe without psychotic symptoms)
- Presence/absence of psychotic symptoms
- Functional impairment level
Historical Pattern Assessment
- Previous manic/hypomanic episodes (duration and features)
- Previous depressive episodes (recurrent depressive disorder pattern)
- History of psychotic features during episodes
- Response to previous treatmentsRe
Practice Tip: Create a timeline of mood episodes to differentiate between bipolar I disorder (true manic episodes) and bipolar type II disorder (hypomanic episodes only).
Some Common Coding Challenges
Challenge 1: Differentiating Bipolar I vs. Bipolar II
While ICD-10 doesn't explicitly separate these as DSM-5 does:
A type 1 excludes note indicates that the specific code should never be used at the same time as F31.
- Use F31.0-F31.7 for bipolar I disorder (history of full manic episodes)
- Use F31.8 for bipolar II disorder (history of hypomanic but never manic episodes)
A type 2 excludes note indicates that the condition excluded is not part of the condition it is excluded from, but both conditions can occur together.
Challenge 2: Coding During Stable Periods
When a patient with confirmed bipolar disorder is currently stable:
- Use F31.7 (bipolar disorder currently in remission)
- Document whether in partial remission or full remission
- Note maintenance medications
Challenge 3: Mixed Presentations
For patients showing both manic and depressive symptoms:
- Use F31.6 (bipolar disorder, current episode mixed)
- Document specific symptoms from both poles
Challenge 4: Psychotic Features
Always specify whether psychotic symptoms are present:
- F31.2: Current manic episode with psychotic symptoms
- F31.5: Current depressive episode with psychotic symptoms
- Note if psychotic features are mood-congruent or mood-incongruent
Some Documentation Templates for putting the appropriate code
Initial Diagnosis Template
"Patient presents with [specific symptoms] for [duration]. History reveals [previous episodes]. Current presentation consistent with [specific ICD-10 code]. Ruled out [differential diagnoses] based on [clinical observations]."
Follow-Up Documentation Template
"Patient with established bipolar affective disorder, currently in [episode type] of [severity] [with/without] psychotic symptoms. Current presentation warrants [ICD-10 code]. Treatment response: [observations]."
Automating Therapy Documentation with AI
With the advancement of technology, mental health professionals are turning to AI Therapy Note tools like Supanote to automate their documentation. These tools:
- Automatically create nuanced clinical documentation
- Can automatically identify the ICD code for your session
- Prevent billing and coding errors
- Reduce time spent on paperwork, allowing more focus on patient care
For example, at the end of a session with a bipolar patient, Supanote would directly generate the relevant progress notes in your preferred format (SOAP, DAP, GIRP, etc.), along with a mental status examination, and relevant CPT and ICD codes.
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Quick-Reference Case Examples
Case 1: First Presentation of Mania
Scenario: 22-year-old with no psychiatric history, presenting with 2 weeks of decreased sleep need, excessive energy, grandiose plans, and racing thoughts.
Code: F30.1 (Manic episode without psychotic symptoms)
Rationale: First episode without established bipolar pattern.
Case 2: Bipolar Depression
Scenario: 45-year-old with previous manic episodes, now experiencing severe depression with suicidal ideation.
Code: F31.4 (Bipolar disorder, current episode depressed, severe without psychotic symptoms)
Rationale: Depressive episode in context of established bipolar disorder.
Scenario: 30-year-old with a history of hypomanic episodes, now experiencing mild depressive symptoms.
Code: F31.3 (Bipolar disorder, current episode depressed, mild or moderate severity)
Rationale: Even mild depressive episodes in bipolar disorder should be coded using the F31.x series to reflect the bipolar diagnosis. F32.x codes are reserved for unipolar depression.
Case 3: Bipolar with Psychotic Features
Scenario: 35-year-old in manic state with delusions of special powers and hallucinations.
Code: F31.2 (Bipolar disorder, current episode manic severe with psychotic symptoms)
Rationale: Current manic episode includes psychotic features.
Frequently Asked Questions
Q. How do I code for a patient who meets DSM-5 criteria for Bipolar II but I need an ICD-10 code?
A. Use F31.8 (Other bipolar affective disorders). In your documentation, specify "Bipolar II Disorder per DSM-5 criteria" to clarify your diagnostic reasoning.
Q. Can bipolar coding change during treatment?
A. Yes, update the ICD-10 code as clinical presentation changes. A patient initially coded with current episode manic may later be coded as current episode depressed or currently in remission.
Q. How do I differentiate between schizoaffective disorder, bipolar type and bipolar with psychotic symptoms?
A. The key distinction is timing: use F25.0 (schizoaffective disorder, bipolar type) when psychotic symptoms persist for at least two weeks in the absence of prominent mood symptoms. Use F31.2/F31.5 when psychotic symptoms occur only during mood episodes.
Q. When should I use the "unspecified" bipolar disorder code?
A. Use F31.9 (Bipolar disorder unspecified) temporarily when clinical evidence supports bipolar disorder but insufficient information exists to determine specific episode type.
Q. My patient has bipolar disorder but is currently stable on medication. What's the appropriate code?
A. Use F31.7 (Bipolar disorder, currently in remission) and specify whether in partial remission or full remission in your documentation.
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Remember: accurate coding isn't just about reimbursement. It's about communicating precise clinical understanding that guides appropriate treatment for manic depressive illness. Behind every code is a person experiencing a complex mental illness that requires our careful attention and expertise.
