Thursday, January 3, 2019

Factitious Disorders

Factitious: a word meaning artificially created according to the dictionary.  Synonyms include false, feign, pretended, or contrived.  So what does that word have to do with ICD-10-CM coding?  Well, in the 2019 ICD-10-CM code updates, the category of F68.1 Factitious disorder was revised and knowing the meaning of the word factitious goes a long way in understanding the code’s evolution.  In this edition of “In the kNOW” we will delve a little deeper into this disorder and the new codes created for usage.

Let’s begin by examining what a factitious disorder is.  Individuals with a factitious disorder make a conscious determination to act as if they or a person they care for have a physical or mental illness when, indeed, they do not.  They act in that manner to gain attention and this can include lying or faking symptoms, altering the results of tests, or intentionally hurting themselves.  This is different from those individuals who are characterized as malingerers.  A malingerer is motivated by factors like financial gain (insurance fraud), obtaining controlled medications, or getting out of work.

Factitious disorders are characterized as a type of mental illness and are found in Chapter 5 of the ICD-10-CM code book.  With the 20019 code updates, Category F68.1 for factitious disorder was revised becoming F68.1 factitious disorder imposed on self (Mϋnchausen’s syndrome) and F68.A factitious disorder imposed on another, otherwise known as Mϋnchausen’s by proxy.  In Mϋnchausen’s by proxy, an individual feigns illness in someone under his or her care in order to gain attention.  This has often been seen with mothers and children, but it can also happen with caregivers of elderly individuals or those with a disability.  A new coding guideline at Section I.C.5.c instructs coders that the code for Mϋnchausen’s by proxy should be assigned only on the perpetrator’s record. 

The factitious disorder imposed on self is further broken down into four main types:

  • F68.10    Unspecified  
  • F68.11    With predominately psychological signs and symptoms 
    • Hallucinations 
    • Hearing things 
    • Confusion 
  • F68.12    With predominately physical signs and symptoms
    • Stomach pain 
    • Chest pain 
  • F68.13     With combined psychological and physical signs and symptoms

It can be difficult for a physician to diagnosis a factitious disorder.  Some of the clues that can assist with determining if a diagnosis of factitious disorder is appropriate are:
  • Numerous admissions at different healthcare facilities and/or with different doctors 
  • Over eagerness for treatment including surgical procedures 
  • Familiarity with  medical knowledge including illnesses and terminology 
  • Increase/change in symptoms and their severity after treatment

While this may not be a common condition, you now have the background and knowledge to assign the appropriate code for a factitious disorder should the need arise.

Now you are In the

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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