Comorbidities are those associated with the use of illicit substances (in the case of illegal stimulants or phencyclidine) or diversion of prescribed stimulants. Comorbidities related to steroid or immunosuppressant medications are those medical indications for these preparations. Delirium can occur before or along with manic symptoms in individuals in- gesting phencyclidine or those who are prescribed steroid medications or other immuno- suppressant medications.
Due to Another Medical Condition
A. A prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that predominates in the clinical picture.
There is evidence from the history. physical examination, or laboratory findings that the dis- turbance is the direct pathophysiological consequence of another medical condition.
. The disturbance is not better explained by another mental disorder.
. The disturbance does not occur exclusively during the course of a delirium.
. The disturbance causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning, or necessitates hospitalization to pre- vent harm to self or others, or there are psychotic features.
Coding note: The lCD-9-CM code for bipolar and related disorder due to another medical condition is 293.83, which is assigned regardless of the specifier. The |CD-10-CM code depends on the specifier (see below).
.03
Specify if: (F0633) With manic features: Full criteria are not met for a manic or hypomanic ep- isode.
(F0633) With manic- or hypomanic-like episode: Full criteria are met except Crite- rion D for a manic episode or except Criterion F for a hypomanic episode.
(F0634) With mixed features: Symptoms of depression are also present but do not predominate in the clinical picture.
Coding note: Include the name of the other medical condition in the name of the mental disorder (e.g., 293.83 [F0633] bipolar disorder due to hyperthyroidism, with manic tea- tures). The other medical condition should also be coded and listed separately immedi- ately before the bipolar and related disorder due to the medical condition (e.g., 242.90 [E0590] hyperthyroidism; 293.83 [F0633] bipolar disorder due to hyperthyroidism, with manic features).
The essential features of bipolar and related disorder due to another medical condition are presence of a prominent and persistent period of abnormally elevated, expansive, or irri- table mood and abnormally increased activity or energy predominating in the clinical pic- ture that is attributable to another medical condition (Criterion B). In most cases the manic or hypomanic picture may appear during the initial presentation of the medical condition (i.e., within 1 month); however, there are exceptions, especially in chronic medical condi- tions that might worsen or relapse and herald the appearance of the manic or hypomanic picture. Bipolar and related disorder due to another medical condition would not be diag- nosed when the manic or hypomanic episodes definitely preceded the medical condition, since the proper diagnosis would be bipolar disorder (except in the unusual circumstance in which all preceding manic or hypomanic episodes—or, when only one such episode has occurred, the preceding manic or hypomanic episode—were associated with ingestion of a substance/medication). The diagnosis of bipolar and related disorder due to another medical condition should not be made during the course of a delirium (Criterion D). The manic or hypomanic episode in bipolar and related disorder due to another medical con- dition must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning to qualify for this diagnosis (Criterion E).