“Anxiety is a vague uneasy feeling of discomfort of dread accompanied by an autonomic response.” These responses represent dynamic adjustments to the auto-regulatory functions that keep us alive, including changes in heart rate, blood pressure, sweating and even pupil dilation. Autonomic responses are brought together or integrated mainly with emotions and feeling states. The source is often non-specific or unknown to the individual. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with the threat. Unspecified anxiety disorder is identified in ICD-10 with the code F41.9 and as coded prior to ICD-10 implementation under ICD-9 as 300.00 (anxiety state, not otherwise specified [NOS]). Anxiety is 28th in the top 30 list of diagnosis codes identified in the emergency medicine diagnosis coding performed at McKesson.
There are many types of anxiety disorders, including:
- Panic disorder: an anxiety disorder characterized by panic attacks much like agoraphobia or an anxiety disorder in which the patient fears and often avoids situations or places that might cause panic or have fear or terror.
- Social anxiety disorder: concerns about everyday social encounters and being judged by others or behaving in a way that might cause embarrassment.
- Generalized anxiety: anxious about almost everything, excessive unrealistic worry.
“All humans experience fear and anxiety. Fear is an emotional, physiologic, and behavioral response to a recognized external threat (e.g., an intruder or a runaway car). Anxiety is an unpleasant emotional state; its causes are less clear. Anxiety is often accompanied by physiologic changes and behaviors similar to those caused by fear.”
If symptoms of anxiety disorder are present, such as chest pain or discomfort, choking, dizziness, fear of “going crazy,” flushes or chills, trembling or shaking and other symptoms, the doctor will typically begin an evaluation by asking questions about the patient’s medical history and performing a physical examination. There are no specific lab tests to diagnose anxiety disorders, but the physician may use various tests to look for a physical illness that may be the cause of the symptoms. “Treatment – patients should be told that their disorder results from both biologic and psychologic dysfunction and that pharmacotherapy and behavior therapy usually help control symptoms.”
Drug treatment with antidepressants and benzodiazepines will be considered but often have to be long-term because panic attacks often recur when drugs are discontinued. Other treatment can include: psychotherapy, cognitive behavioral therapy, dietary and life-style changes and relaxation therapy.
As supported by most documented references, anxiety disorders cannot be prevented, but there are some things you can do to control or lessen the symptoms, which include reducing the consumption of caffeine related products, consulting a physician before taking any over the counter medications and also seek counseling if you start to feel anxious for no apparent reasons.
There is a one to one crosswalk (ICD-9 to ICD-10) for anxiety, NOS – see table below, but both ICD-9 and ICD-10 contain many other types and reasons for anxiety including, but not limited to, what is shown on the table below.
ICD-9 Look up and Description
ICD-10 Look up, Code and Description
300.00 – anxiety state, unspecified
Look up as; Anxiety – includes, neurosis, reaction, state (Neurotic) and atypical anxiety disorder
Look up as; Anxiety – F41.9 – anxiety disorder, unspecified
300.01 – Panic disorder without agoraphobia
Look up as; Anxiety, panic type, includes panic attack and panic state
Look up as; Anxiety, panic type – F41.0
300.02 – anxiety, generalized
Look up as; Anxiety - generalized
Look up as; Anxiety generalized – F41.1
300.09 - other
Look up as; Anxiety, if nothing specific use this code
Look up as; Anxiety and if not classified use – F41.3
It is imperative that the provider document exactly what the medical history, examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study. This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement.
- ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015.
- ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013.
- Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.