F31

Bipolar disorder

Bipolar disorder, formerly known as manic-depressive illness, is a chronic and relapsing mental health condition characterized by significant shifts in mood, energy, and activity levels. These fluctuations involve episodes of mania or hypomania (pathological elevation in mood and energy) and episodes of depression (pathological lowering of mood and energy). The disorder is typically categorized into Bipolar I, defined by at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes, and Bipolar II, defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic episodes. The clinical course often includes periods of euthymia (stable mood) interspersed with acute episodes. Severe cases may involve psychotic features, such as hallucinations or delusions, which typically align with the patient's current mood state. Management generally requires a combination of pharmacotherapy (mood stabilizers, antipsychotics) and psychotherapy.

Clinical Symptoms

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (feeling rested after only 3 hours)
  • Pressured speech or being more talkative than usual
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (attention too easily drawn to unimportant stimuli)
  • Increase in goal-directed activity (socially, at work or school, or sexually)
  • Psychomotor agitation (physical restlessness)
  • Excessive involvement in activities with high potential for painful consequences (spending, sexual indiscretions)
  • Depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in all, or almost all, activities (anhedonia)
  • Significant weight loss or gain, or decrease or increase in appetite
  • Insomnia or hypersomnia nearly every day
  • Psychomotor retardation (observed by others, not just subjective feelings)
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death or suicidal ideation
  • Psychotic symptoms such as delusions of grandeur or paranoid ideation during severe episodes

Common Causes

  • Genetic predisposition: High heritability with increased risk among first-degree relatives
  • Neurochemical imbalances: Dysregulation of neurotransmitters including dopamine, serotonin, and norepinephrine
  • Brain structure and function: Abnormalities in the prefrontal cortex, amygdala, and hippocampus
  • Environmental stressors: Childhood trauma, abuse, or significant life stressors can trigger onset
  • Sleep deprivation: Disruption of circadian rhythms can precipitate manic episodes
  • Substance use: Alcohol or drug abuse can trigger or worsen mood episodes
  • Hormonal factors: Thyroid dysfunction or hormonal shifts can influence mood stability

Documentation & Coding Tips

Specify the current clinical episode type to avoid unspecified coding. Documentation must clearly state if the current episode is manic, hypomanic, depressed, or mixed.

Example: Patient with established Bipolar I disorder presents today in a current manic episode. She reports 4 days of decreased need for sleep, increased goal-directed activity in starting a new business, and pressured speech. There are no delusions or hallucinations present. Symptoms are of moderate intensity and significantly impair social functioning. Plan: Increase lithium dosage and follow up in 1 week. Diagnosis: Bipolar disorder, current episode manic without psychotic features, moderate (F31.12).

Billing Focus: Specifying the manic episode and the moderate severity provides the necessary detail to assign the fourth and fifth characters of the ICD-10-CM code.

Document the presence or absence of psychotic features during the current episode. This distinction is critical for selecting between codes like F31.13 and F31.2.

Example: Patient presents with severe depressive symptoms including profound anhedonia and psychomotor retardation. He reports hearing voices telling him he is worthless, indicating mood-congruent psychotic features. He is unable to perform basic activities of daily living. Assessment: Bipolar disorder, current episode depressed, severe, with psychotic features (F31.5).

Billing Focus: The presence of psychotic features changes the sixth character and increases the technical complexity of the code, often supporting higher-level E/M services.

Clearly define the severity of the current mood episode using standardized clinical descriptors such as mild, moderate, or severe.

Example: Evaluation of patient with Bipolar II disorder. Current episode is hypomanic with mild irritability and increased talkativeness, but without significant impairment in social or occupational functioning. No psychotic features or need for hospitalization. Assessment: Bipolar disorder, current episode hypomanic (F31.0).

Billing Focus: Severity level documentation is required for accurate code assignment for manic and depressive episodes within the F31 category.

Indicate if the patient is currently in remission and specify whether the remission is partial or full, as well as the nature of the most recent episode.

Example: Patient has been stable on Quetiapine for 12 months with no return of manic or depressive symptoms. Mental status exam is unremarkable. Assessment: Bipolar disorder, in full remission, most recent episode depressed (F31.74).

Billing Focus: Using remission codes prevents the incorrect billing of active episode codes when a patient is clinically stable, ensuring audit compliance.

Differentiate between Bipolar I and Bipolar II disorders by documenting the history of manic versus hypomanic episodes.

Example: Patient has a history of recurrent major depressive episodes and at least one clearly documented hypomanic episode lasting 5 days, characterized by increased energy and racing thoughts without the need for hospitalization or psychosis. No history of full manic episodes. Assessment: Bipolar II disorder (F31.81).

Billing Focus: Correctly identifying Bipolar II (F31.81) versus Bipolar I ensures the claim reflects the correct diagnostic category as defined by the DSM-5 and ICD-10.

Relevant CPT Codes

Related Diagnoses

Hierarchy