What is the ICD-10 (International Classification of Diseases, 10th Revision) code for catatonia?

ICD-10 Code for Catatonia

The ICD-10 code for catatonia is not a single code, as catatonia is now recognized as a syndrome that can occur in various contexts rather than being solely a subtype of schizophrenia. 1

Understanding Catatonia Classification in ICD-10

• Catatonia is defined as a syndrome of primarily psychomotor disturbances characterized by symptoms including stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia 1
• In ICD-10, catatonia was traditionally considered primarily as a subtype of schizophrenia, but this conceptualization has evolved significantly 1, 2
• The classification of catatonia has been a subject of debate and controversy, with researchers advocating for its recognition as an independent syndrome rather than merely a subtype of schizophrenia 3, 4

Coding Options for Catatonia in ICD-10

Depending on the clinical context, catatonia may be coded as:

• F06.1 - Organic catatonic disorder (when associated with a medical condition) 4
• F20.2 - Catatonic schizophrenia (when occurring in the context of schizophrenia) 1
• F23.2 - Acute schizophrenia-like psychotic disorder with catatonic features 1
• F44.2 - Dissociative stupor (which may present with catatonic features) 1

Evolution of Catatonia Classification

• The conceptualization of catatonia has evolved significantly from being considered exclusively a form of schizophrenia in early classification systems to being recognized as a syndrome that can occur in various psychiatric and medical conditions 5
• Recent research has established that catatonia occurs in approximately 5-18% of psychiatric inpatients and 3.3% of medical inpatients, highlighting its prevalence beyond schizophrenia 2
• The transition from ICD-10 to ICD-11 represents a major shift in how catatonia is classified, with ICD-11 now recognizing catatonia as an independent syndrome rather than primarily a subtype of schizophrenia 5

Clinical Implications for Coding

• Proper identification and coding of catatonia is crucial for appropriate treatment, as early intervention with benzodiazepines or electroconvulsive therapy can significantly reduce morbidity and mortality 2
• When coding catatonia, it's important to document both the catatonic syndrome and any underlying psychiatric or medical condition 5
• Failure to recognize catatonia can lead to delayed treatment and potentially life-threatening complications, making accurate diagnosis and coding essential 2

Important Changes in ICD-11

• In ICD-11 (implemented from January 2022), catatonia has been reclassified as an independent syndrome with four diagnostic categories: catatonia associated with another mental disorder, catatonia induced by substances or medications, secondary catatonia syndrome, and catatonia unspecified 5
• This represents a significant advancement from ICD-10, aligning more closely with current clinical understanding of catatonia as a distinct neuropsychiatric syndrome 2, 5
• The diagnosis in ICD-11 requires at least three clinical features from categories of decreased, increased, or abnormal psychomotor activity 5

Common Pitfalls in Coding Catatonia

• A common error is coding only the underlying condition (e.g., schizophrenia or mood disorder) without specifically coding the catatonic syndrome 4
• Another pitfall is failing to distinguish catatonia from similar presentations such as delirium, severe depression with psychomotor retardation, or factitious disorder 5
• Clinicians should be aware that catatonia can present heterogeneously, with recent research identifying distinct subtypes such as progressive periodic catatonia and chronic system catatonias, each with different clinical and neuropsychological features 6