Classification System for International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision Pediatric Mental Health Disorders

Abstract

all US health care institutions and practitioners transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding system, raising concerns about the validity of examining trends over time in clinical care, costs, and quality. 1 For child mental health disorders, alignment with psychiatric diagnosis groups in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) is also required to consistently examine trends. This is because the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes differ for individual disorders, and child mental health disorders are reclassified under new psychiatric diagnosis groups. We thus developed the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS), which classifies child mental health disorders across coding systems and aligns with DSM-5 psychiatric diagnosis groups. To examine our system's performance, we compared detection of these disorders in a Medicaid claims database against the Clinical Classification Software (CCS) groups 2 and then examined identification of the disorders across ICD-9-CM and ICD-10-CM coding systems using a national pediatric hospitalization database.Methods | Following the general equivalency mapping guidelines, 3 all ICD-9-CM and ICD-10-CM mental health diagnoses, source code descriptions, and corresponding DSM-5 categories were flagged as equal, approximate, or no match, and codes in the ICD-9-CM that linked to more than 1 ICD-10-CM code were identified. Backward and forward reference mappings were iteratively reviewed by a team of 2 board-certified child psychiatrists (B.T.Z. and C.R.), a senior pediatric researcher (J.C.G.), a statistician (J.R.), and a coding expert (A.D.). Of the 19 DSM-5 diagnostic groups, 15 were maintained, 3 were combined to create sexuality and gender identity disorders, and the former category neurodevelopmental disorders was broken out to include 7 discrete child-onset diagnosis groups. The ICD-10-CM codes that specified intentional self-harm were used to create the suicide or self-injury group. The remaining ICD-10-CM codes were grouped into 6 problem categories: namely, accidental or undetermined poisoning; maternal mental illness or substance abuse during pregnancy, delivery, or post partum; substance abuse-associated medical illness; fetal or newborn damage associated with maternal substance abuse; child mental health symptoms (eg, irritability); and miscellaneous conditions (eg, academic underachievement). The complete set of codes is available online. 4 To compare the results of the child mental health disorder groups with an existing adult-based classification scheme,

Patient Risk Factors for Violent Restraint Use in a Children’s Hospital Medical Unit

“…Third, we did not have information on several important risk factors for restraint use, such as history of psychological trauma, social services involvement, history of aggression or restraint use before the hospitalization, baseline psychotropic medication use, and characteristics of the school, home, and family environment, which are known predictors of unsafe behaviors in children and adolescents. Lastly, psychiatric diagnosis obtained from the patient's electronic health record may not meet strict diagnostic criteria, 14 and for some patients, psychiatric diagnoses identified by the clinical team may not have been formally associated with the hospitalization in the discharge or billing summary and therefore could be missing in our data set.…”

US Pediatric Emergency Department Visits for Mental Health Conditions During the COVID-19 Pandemic

“…We collected data from the electronic medical record of 11 490 patients aged 5 to 24 years presenting to a tertiary children’s hospital ED between January 1, 2018, and January 1, 2021, with a MH diagnosis, 6 MH chief concern, positive MH screening test result, MH evaluation, or requirement of physical restraint or safety observation. We compared the characteristics of ED MH visits before (from January 2018 to March 2020) and during (from April to December 2020) the COVID-19 pandemic.…”

Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic

“…We defined pediatric mental health ED visits as those with a primary International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code in the previously validated Child and Adolescent Mental Health Disorders Classification Scheme (CAMHD-CS). 12 While the classification scheme consists of 30 mental health diagnosis groups, we included 15 CAMHD-CS diagnosis groups representative of mental health conditions that are common reasons for ED visits and hospitalizations among children (Table S1). 13,14 We chose to include the mental health diagnosis group titled "Miscellaneous" 12 as it contained relevant ICD-10-CM codes such as "other emotional disturbances of childhood," "persistent mood disorder, unspecified," and "mental disorder not otherwise specified.…”