Step-by-Step Coding Guide for I5900: Bipolar Disorder

1. Review of Medical Records

Objective: Verify the resident has a diagnosis of bipolar disorder documented by a physician or licensed practitioner.
Actions:

• Access the resident's medical records, including progress notes, discharge summaries, and the most recent history.
• Confirm that bipolar disorder has been documented by a physician, nurse practitioner, physician assistant, or clinical nurse specialist within the last 60 days.

2. Understanding Definitions

I5900: Bipolar Disorder: This item refers to a diagnosis of bipolar disorder or manic-depressive illness, which is a psychiatric disorder characterized by extreme mood swings, including periods of mania and depression.

• Bipolar I Disorder: Defined by manic episodes lasting at least 7 days, or by manic symptoms severe enough to require hospitalization. Depressive episodes usually occur as well.
• Bipolar II Disorder: Defined by a pattern of depressive and hypomanic episodes, but not the full-blown manic episodes found in Bipolar I.

Illustration 1:

Scenario: A resident is diagnosed with bipolar disorder with alternating episodes of mania and depression. The diagnosis is clearly documented by a physician.

Result: I5900 is coded "Yes" because the condition has been documented and is active.

3. Coding Instructions

Step-by-Step:

• Step 1: Review the medical record to confirm that bipolar disorder is listed as a diagnosis.
• Step 2: Ensure the diagnosis is active within the 7-day look-back period, meaning the resident is receiving treatment or monitoring for the condition.
• Step 3: If bipolar disorder is documented and actively managed, mark I5900 as "Yes".
• Step 4: If no such diagnosis is present, or the condition is no longer active, mark "No".

Illustration 2:

Scenario: A resident was diagnosed with bipolar disorder years ago but is not currently receiving treatment or being monitored for the condition.

Result: I5900 is coded "No", as the condition is not actively affecting the resident's care.

4. Coding Tips

• Active Diagnosis: Ensure that the condition is active during the 7-day look-back period. Active diagnoses include those that directly impact the resident's functional status, treatment, or monitoring​.
• Clear Documentation: Make sure that bipolar disorder is specifically documented by the healthcare provider in the resident's medical records.

5. Documentation

Objective: Ensure that the resident’s bipolar disorder is accurately documented, including the type (Bipolar I or II), and its impact on the resident’s current health status.
Actions:

• Document the physician’s diagnosis, as well as any medication or therapy the resident is receiving for bipolar disorder.
• Include any relevant notes regarding mood episodes, medication adjustments, or monitoring of the condition.

Illustration 3:

Scenario: A resident’s chart includes a note from their psychiatrist stating that the resident is being treated for Bipolar I Disorder and is currently on a mood stabilizer.

Documentation: The diagnosis and treatment are clearly documented, and I5900 is coded "Yes".

6. Common Errors to Avoid

• Misclassifying Diagnoses: Do not code I5900 for other mood disorders (e.g., depression without mania), which are classified separately under I5800 (Depression).
• Incomplete Records: Ensure that there is complete documentation from a healthcare provider indicating the presence and treatment of bipolar disorder.

Illustration 4:

Scenario: A resident is listed as having mood swings, but there is no formal diagnosis of bipolar disorder documented by a physician.

Error: Without a formal diagnosis, I5900 should not be coded as "Yes".

7. Practical Application

• Example 1: A resident with Bipolar II Disorder experiences depressive episodes, and the medical records indicate ongoing treatment with antidepressants and mood stabilizers. I5900 is coded "Yes".
• Example 2: A resident has depression but no documented history of manic or hypomanic episodes. I5900 is coded "No".

Please note that the information provided in this guide for MDS 3.0 Item set I5900 was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0.  

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding.  

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.