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Related Experiment Videos

Coding of pediatric behavioral and mental disorders.

Jerry L Rushton1, Barbara T Felt, Mary W Roberts

  • 1Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA. jrushton@umich.edu

Pediatrics
|July 3, 2002
PubMed
Summary

Physicians frequently use alternate coding for behavioral and mental disorders due to reimbursement and diagnostic challenges. Practices vary significantly by specialty, highlighting a need to align clinical diagnosis with administrative coding.

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Area of Science:

  • Pediatric Health
  • Medical Coding Practices
  • Mental Health Diagnosis

Background:

  • Physicians face healthcare pressures leading to alternate coding for clinical diagnoses.
  • Limited information exists on how pediatric specialists handle coding for behavioral and mental disorders.

Purpose of the Study:

  • To determine the frequency and approaches to alternate coding used by physicians.
  • To explore physician attitudes towards diagnosis and coding practices across specialties.

Main Methods:

  • A mail survey was distributed to 1492 physicians: developmental/behavioral pediatricians (DBP), pediatricians (PED), and child/adolescent psychiatrists (PSY).
  • Survey outcomes included frequency of alternate coding, coding strategies (somatic symptoms, modifiers, substitutions), and attitudes via Likert scales.

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  • Data were analyzed by specialty and demographics using chi-squared tests and logistic regression.

    • Main Results:

    • A high response rate (62%) was achieved, with a majority of physicians reporting alternate code use (DBP 83%, PED 68%, PSY 58%).
    • Frequent alternate coding (monthly-daily) was reported by a significant portion of respondents (DBP 60%, PED 36%, PSY 27%).
    • Reimbursement and diagnostic classification challenges were primary drivers, though stigmatization and parental acceptance were also noted. Few practices had organized administrative methods for alternate coding.

    Conclusions:

    • Alternate coding is prevalent but varies by physician specialty, particularly for pediatric behavioral and mental health conditions.
    • While reimbursement is a factor, diagnostic classification complexities are critical for this patient population.
    • Revisiting the distinct purposes of clinical diagnosis and administrative coding is necessary, with further research on the impact of current practices.