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					                                   WINDSTONE BEHAVIORAL HEALTH ENCOUNTER SUPERBILL
MAJOR DEPRESSION, BIPOLAR & PARANOID DISORDERS                                        WBH Location:              GG1       GG2           LH         PD             Torrance
      *      Requires a fifth digit
    296.0*   Bipolar I disorder, single manic episode
    296.1*   Manic Disorder, recurrent episode                                    Name: ______________________________________________________________
    296.2*   Major depressive disorder, single or unspecified
    296.3*   Major Depressive disorder, recurrent
    296.4*   Bipolar I disorder, manic                                            DOS: ________________________________               Copay due: $________________
    296.5*   Bipolar I disorder, depression
    296.6*   Bipolar I disorder, mixed
                  * Fifth digit please CHECK ONE (√)                              DOB: ________________________________               Copay paid: ________________
                        0     Unspecified
                        1     Mild
                        2     Moderate                                            Insurance: ____________________________             Med Group: ________________
                        3     Severe, without psychotic behavior
                        4     Severe, with psychotic behavior
                        5     In partial or unspecified remission                 Provider Name: ______________________________________________________
                        6     In full remission
    296.7    Bipolar I disorder, unspecified
    296.80   Bipolar Disorder Unspecified
    296.81   Atypical Manic Disorder
    296.82   Atypical depressive disorder                                                    MD, DO, NP ONLY                          Psychologist, LCSW, MFT ONLY
    296.89   Bipolar II disorder                                                  CHECK ONE (√)                                CHECK ONE (√)
    297.0    Paranoid State, Simple
    297.1    Delusional Disorder                                                  _________ 90801 Psych Diagnostic Interview   ______ 90801Psych Diagnostic Interview
                                                                                                                                              CHECK ONE (√)
                                                                                  __________99205 New OP Evaluation
                 DEPRESSIVE DISORDERS                                             __________90805 Individual Psychotherapy                     _____
                                                                                                                               _______ 90806 Individual Psychotherapy (45-50
                                                                                      CHECK ONE (√)
             Dysthymic Disorder (specify Early Onset/Late Onset; specify atypical w/ E&M (20-30 Min time required in chart)                    90801/99205 Non-
                                                                                                                               minutes time required in chart).
                                                                                                                                               Psych Diag.
     300.4   features).                                                           _________ 90807 Individual Psychotherapy                             Interview
    301.13   Cyclothymic Disorder                                                 w/ E&M (45-50 min time required in chart)    _______ 90808 Individual Psychotherapy (75-80
                                                                                                                                               _____ 90806 Ind.
                           Schizophrenia                                                                                       minutes time required in chart)
                                                                                  _________ 90862 Medication Management
      *      Requires a fifth digit                                                                                            _______ 90847 Family Psychotherapy
    295.0*   Schizophrenia Simple type                                            _________ 99214 E&M Detailed Moderate
    295.1*   Schizophrenia Disorganized type                                                                                   _______ 90853 Group Psychotherapy
                                                                                  _________ 90853 Group Psychotherapy
    295.2*   Schizophrenia Catatonic Type                                         _________ No Show
    295.3*   Schizophrenia Paranoid type                                          _________ Same Day Cancel                    _______ No Show
    295.4*   Schizophreniform disorder                                            _________ Other _____________________        _______ Same Day Cancel
                                                                                                                               _______ Other _______________________
    295.5*   Latent Schizophrenia
    295.6*   Schizophrenia Residual type
    295.7*   Schizoaffective disorder
    295.8*   Other specified types of Schizophrenia                                                                              Dementia
    295.9*   Unspecified types of Schizophrenia                                                          290.0             Senile Dementia uncomplicated
                  * Fifth digit please CHECK ONE (√)                                                    290.10             Presenile Dementia uncomplicated
                       0 Unspecified                                                                    290.13             Presenile Dementia with depressive features.

                       1     Subchronic                                                                 290.21             Senile Dementia with depressive features

                                                                                                                           Dementia Alzheimer's Type Early/Late Onset without
                       2     Chronic                                                                    294.10             Behavioral disturbance (also code Axis III 331.0)

                                                                                                                           Dementia Alzheimer's Type Early/ Late Onset with
                       3     Subchronic with acute exacerbation                                         294.11             Behavioral disturbance (also code Axis III 331.0)
                       4     Chronic with acute exacerbation                                            290.40             Vascular Dementia uncomplicated
                       5     In remission                                                               290.41             Vascular Dementia with Delirium
                     Psychotic Disorders                                                                290.42             Vascular Dementia with Delusions
    298.8    Brief Psychotic Disorder                                                                   290.43             Vascular Dementia with Depressed mood
    297.3    Shared Psychotic Disorder                                                                   290.9             Unspecified Senile Psychotic Condition
             Psychotic Disorder with delusion Due to: (indicate general medical
    293.81   condition on Axis III)                                                                                        Axis III disease's to support Axis I diagnoses
             Psychotic Disorder with hallucinations Due to: (indicate general
    293.82   medical condition on Axis III)                                                              042               HIV Disease
     293.0   Delirium Due to: (indicate medical condition on Axis III).                                 854.00             Head Trauma
              Drug and Alcohol Dependence                                                               331.82             Parkinson's Disease
      *      Requires a fifth digit                                                                      333.4             Huntington's Disease
    303.0*   Acute Alcoholic Intoxication                                                               331.11             Pick' s Disease
    303.9*   Other and Unspecified alcohol dependence                                                    046.1             Creutzfeldt-Jakob Disease
    304.0*   Opioid type dependence                                                                      331.0             Alzheimer's Disease
    304.1*   Sedative, hypnotic and anxiolytic dependence                                                437.0             Cerebral Atherosclerosis
    304.2*   Cocaine dependence                                                                         V12.54             Status Post TIA/ CVA
    304.3*   Cannabis dependence                                                                 Anxiety Disorders
    304.4*   Amphetamine and other Psychostimulant dependence                                           300.00             Anxiety State unspecified
    304.5*   Hallucinogen dependence                                                                    300.01             Panic Disorder w/o Agoraphobia
    304.6*   Other Specified drug dependence                                                            300.02             Generalized Anxiety Disorder
    304.7*   Combinations of opioid type drug with any other                                            300.21             Panic Disorder w/ Agoraphobia
    304.8*   Comb drug dependence excluding opioid type drug                                            300.22             Agoraphobia without hx of panic disorder
    304.9*   Unspecified Drug Dependence                                                                300.23             Social Phobia (specify if generalized)
                  * Fifth digit please CHECK ONE (√)                                                    300.29             Specific Phobia (specify type - animal/natural)
                                                                                                                           Obsessive Compulsive Disorder: specify if with poor
                       0     Unspecified                                                                 300.3             insight

                       1     Continuous                                                                  308.3             Acute Stress Disorder
                                                                                                                           Post Traumatic Stress Disorder (specify if
                       2     Episodic                                                                   309.81             acute/chronic or delayed onset)
                       3     In Remission
Name:    ______________________________________________


DOS:     ______________________________________________


DOB:     ______________________________________________

                  WINDSTONE BEHAVIORAL HEALTH ENCOUNTER SUPERBILL
           Drug and Alcohol Psychosis                                              Personality Disorders
291.0    Alcohol withdrawal delirium                                      301.0            Paranoid Personality Disorder
291.1    Alcohol induced persisting amnestic disorder                    301.20            Schizoid Personality Disorder unspecified
291.2    Alcohol induced persisting dementia                             301.22            Schizoid Personality Disorder
291.3    Alcohol induced psychotic disorder w/ hallucinations             301.4            Obsessive-Compulsive Personality Dis.
294.4    Idiosyncratic alcohol intoxication (drunkenness)                301.50            Histrionic Personality Disorder Unspecified
291.5    Alcohol induced psychotic disorder with delusion                 301.6            Dependent Personality Disorder
291.81   Alcohol withdrawal                                               301.7            Antisocial Personality Disorder
292.0    Drug withdrawal                                                 301.81            Narcissistic Personality Disorder
292.11   Drug induced psychotic disorder with delusions                  301.82            Avoidant Personality Disorder
292.12   Drug induced psychotic disorder w/ hallucinations               301.83            Borderline Personality Disorder
292.2    Pathological drug intoxication                                  Other Behavioral Health Diagnoses
292.81   Drug induced delirium                                            309.0            Adjustment Disorder with Depressed Mood
292.82   Drug induced persisting dementia                                309.24            Adjustment Disorder with Anxiety
                                                                                           Adjustment Disorder with mixed Anxiety and
292.83   Drug induced persisting amnesic disorder                        309.28            Depressed mood
292.84   Drug induced mood disorder                                       309.3            Adjustment Disorder with disturbance of conduct
                                                                                           Adjustment Disorder with mixed disturbance of
292.89   Drug induced Anxiety disorder                                   309.4             conduct
292.9    Unspecified Drug induced Mental disorders                                    Eating Disorders
          Other Behavioral Health Disorders                               307.1            Anorexia Nervosa
307.20   Tic Disorder, Unspecified                                       307.51            Bulimia Nervosa
307.21   Transient Tic Disorder                                          307.50            Eating Disorder Unspecified
307.23   Tourette's Disorder                                                          Sleep Disorders
313.81   Oppositional Defiant Disorder                                   307.42            Primary Insomnia
 313.9   Unspecified Emotional disturbance of childhood or adolescence   307.46            Sleepwalking Disorder
314.00   ADD without mention of Hyperactivity                            307.47            Nightmare Disorder
314.01   ADD with Hyperactivity                                                   Drug and Alcohol Abuse
 314.1   Hyperkinesis with developmental delay                             *               Requires a fifth digit
 314.2   Hyperkinetic conduct disorder                                   305.0*            Alchohol Abuse NOS
 314.9   Hyperkinetic syndrome NOS                                       305.2*            Cannabis Abuse
315.90   Developmental Disorder NOS                                      305.3*            Hallucinogen Abuse
                     Other Diagnosis                                     305.4*            Sedative, Hypnotic or anxiolytic Abuse
                                                                         305.5*            Opioid Abuse
                                                                         305.6*            Cocaine Abuse
                                                                         305.8*            Antidepressant type Abuse
                                                                         305.9*            Other, Mixed or Unspecified drug Abuse
                                                                                                * Fifth digit please CHECK ONE (√)
                                                                                                     0 Unspecified
                                                                                                     1 Continuous
                                                                                                     2 Episodic
                                                                                                     3 In Remission

				
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posted:4/10/2011
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