Getting the ICD-10-CM coding right for bipolar disorder can feel like a maze. The distinctions between bipolar I, bipolar II, and other variants significantly impact treatment planning and insurance reimbursement. Many therapists find themselves second-guessing their diagnostic codes or documentation practices.

The complexity involves more than just memorizing code numbers. Each subtype of bipolar disorder has specific criteria, documentation needs, and clinical considerations affecting everything from assessment to billing. Missing these details can lead to claim denials, treatment delays, or inadequate care coordination.

This guide breaks down the key ICD-10-CM codes for bipolar spectrum disorders that therapists encounter most frequently. You'll learn about diagnostic differentials, documentation best practices, and practical tips for accurate coding that supports both clinical care and administrative efficiency.

Overview of Bipolar Spectrum

The bipolar spectrum includes several distinct disorders, each with unique diagnostic criteria and treatment implications. Bipolar I disorder requires at least one manic episode lasting seven days or needing hospitalization. Bipolar II involves hypomanic episodes (lasting at least four days) alternating with major depressive episodes.

Cyclothymic disorder presents as chronic mood instability with many hypomanic and depressive symptoms over two years. Other specified bipolar disorders capture presentations that don't meet full criteria but cause significant impairment. The spectrum also includes substance-induced bipolar disorder and bipolar disorder due to medical conditions.

Key features distinguishing these disorders include episode duration, severity, and functional impact. Manic episodes involve elevated or irritable mood with increased activity, decreased sleep need, and possible psychotic features. Hypomanic episodes share similar symptoms but without marked impairment or psychosis.

Accurate diagnosis requires longitudinal assessment beyond single episodes. Many clients initially present during depressive phases, making bipolar disorder easy to miss. Gathering detailed history about past mood episodes, family psychiatric history, and treatment response patterns proves vital for proper identification.

ICD-10-CM Codes Therapists Need to Know

Knowing the specific ICD-10-CM codes for bipolar disorder helps ensure accurate documentation and appropriate reimbursement. Here are the F31 codes you'll use most frequently in practice:

• F31.0 - Bipolar I disorder, current episode hypomanic: Used when a client with a known history of at least one manic episode is currently experiencing a hypomanic episode (elevated mood without full manic severity or psychotic features)..
• F31.1 - Bipolar I disorder, current episode manic without psychotic features: Applies to full manic episodes with marked impairment but no delusions or hallucinations.
• F31.2 - Bipolar I disorder, current episode manic with psychotic features: Documents manic episodes accompanied by delusions or hallucinations, whether mood-congruent or incongruent.
• F31.3 - Bipolar I disorder, current episode depressed, mild or moderate severity: Captures depressive episodes with functional impairment but without severe symptoms or psychosis.
• F31.4 - Bipolar I disorder, current episode depressed, severe without psychotic features: For severe depression causing significant impairment but no psychotic symptoms.
• F31.5 - Bipolar I disorder, current episode depressed, severe with psychotic features: Documents severe depression with delusions or hallucinations present.
• F31.6 - Bipolar I disorder, current episode mixed: Used when criteria for both manic and depressive episodes are met simultaneously or in rapid alternation.
• F31.7 - Bipolar I disorder, currently in remission: Applies when the client has a history of bipolar I but currently shows no significant mood symptoms.
• F31.8 - Other bipolar disorder: Used for specific non-standard presentations that don’t fit into other categories.
• F31.81- Bipolar II disorder, depressed episode: Used when the client has a history of at least one major depressive episode and at least one hypomanic episode, but never a full manic or mixed episode. This code is typically used to represent the disorder when the client's current or most recent episode is depressed.
• F31.9 - Bipolar disorder, unspecified: Reserved for when insufficient information exists for specific coding.

Diagnostic Assessment and Differential

Distinguishing bipolar disorder from other conditions requires systematic evaluation, as many psychiatric disorders share overlapping symptoms. Unipolar depression often hides bipolar disorder, especially when clients present during depressive episodes without mentioning past hypomanic or manic periods. ADHD can imitate hypomanic symptoms with its hyperactivity and impulsivity, while trauma-related disorders may show mood changes that resemble bipolar cycling, although for these conditions, symptoms are typically chronic and non-episodic, representing the client's baseline rather than a distinct change

Structured assessment tools improve diagnostic accuracy:

• Mood Disorder Questionnaire (MDQ): A 13-item screening tool that identifies lifetime history of manic or hypomanic symptoms
• Composite International Diagnostic Interview (CIDI): Comprehensive structured interview covering DSM criteria for bipolar spectrum disorders
• Life Chart Method: Visual timeline mapping mood episodes, hospitalizations, and treatment responses across the lifespan

Collateral information is important for detecting manic and hypomanic episodes. Clients often lack insight during elevated mood states or may not recognize hypomania as problematic. Family members, partners, or close friends can provide important observations about behavior changes, sleep patterns, and functional impacts that clients might minimize or forget.

Key differential considerations include:

• Borderline Personality Disorder: Mood instability occurs within hours or days rather than distinct episodes lasting weeks
• Substance-Induced Mood Disorder: Requires careful timeline analysis of substance use and mood symptoms
• Medical Conditions: Thyroid disorders, neurological conditions, and certain medications can produce bipolar-like presentations

Document your differential diagnosis process thoroughly, including which conditions you ruled out and your clinical reasoning. This supports appropriate ICD-10-CM coding and shows the need for ongoing treatment.

Clinical Documentation Best Practices

Accurate documentation for bipolar disorder involves capturing specific clinical details that support your ICD-10-CM coding and treatment decisions. Your notes should clearly identify the current episode type (manic, hypomanic, depressive, or mixed) along with severity indicators that justify the chosen code.

Key elements to document include:

• Episode characteristics: Specify duration, onset date, and whether this represents a new episode or continuation of previous symptoms
• Severity markers: Note functional impairment level, hospitalization risk, and impact on work, relationships, or self-care abilities
• Psychotic features: Document any delusions or hallucinations, specifying whether mood-congruent or incongruent
• Safety concerns: Include suicidal ideation, homicidal thoughts, or risky behaviors associated with the current episode

Link observed symptoms directly to functional impairments and your treatment approach. For example, document how decreased sleep and increased goal-directed activity interfere with the client's job performance, then explain how your interventions address these specific symptoms.

Update your ICD-10-CM codes as the clinical presentation shifts. A client might transition from F31.4 (severe depression without psychosis) to F31.7 (remission) or shift to F31.1 (manic without psychosis). Your documentation should reflect these changes with clear rationale for code updates.

Avoid vague language like "mood swings" or "doing better." Instead, use specific behavioral observations: "Client reports sleeping 2-3 hours nightly for past week, started three new business ventures, and maxed out credit cards totaling $15,000." This precision supports medical necessity and helps other providers understand the clinical picture.

Treatment and Coordination

Treating bipolar disorder effectively involves combining psychotherapy with medication management. As a therapist, you engage in specific interventions while coordinating closely with prescribing providers to ensure comprehensive care.

Psychotherapy interventions for bipolar disorder focus on three core areas:

• Psychoeducation: Educate clients about bipolar disorder's neurobiological basis, episode patterns, and medication importance. Involve family members when possible to create a supportive environment that recognizes early warning signs.
• Relapse prevention planning: Develop personalized strategies to identify triggers, early symptoms, and protective factors. Create action plans detailing specific steps clients take when noticing mood changes, including when to contact providers.
• Rhythm stabilization: Use Interpersonal and Social Rhythm Therapy (IPSRT) techniques to regulate sleep-wake cycles, meal times, and activity levels. Consistent daily routines significantly reduce episode frequency and severity.

Collaboration with psychiatry is important for optimal outcomes. Regular communication about mood changes, medication side effects, and treatment response helps psychiatrists make informed prescribing decisions. Document all coordination efforts, including consultation dates and shared treatment planning discussions.

Crisis planning requires special attention with bipolar clients. Develop written safety plans addressing both manic and depressive episodes, including:

• Emergency contact information for providers and support persons
• Specific warning signs requiring immediate intervention
• Strategies for managing impulsive behaviors during manic episodes
• Steps for accessing crisis services or hospitalization when needed

Document all safety planning thoroughly, updating plans as clients' presentations change. Include copies in the medical record and ensure clients have accessible versions. Regular review of crisis plans during stable periods improves their effectiveness during actual episodes.

Insurance and Billing Considerations

Choosing the right ICD-10-CM code directly affects reimbursement and authorization for ongoing treatment. Insurance companies carefully check if your documented symptoms and functional impairments match the submitted diagnosis code. Using F31.9 (unspecified bipolar disorder) when you have clear information about the current episode type often leads to denials or requests for more documentation.

Match your code precisely to the client's current situation:

• Active episode coding: Use specific codes (F31.0-F31.6) that reflect the current mood state and severity instead of general codes.
• Document medical necessity: Link symptoms to specific functional impairments in work, relationships, or daily activities.
• Update codes promptly: Change codes when clients transition between episodes or move into remission.

Improve billing accuracy with appropriate Z-codes for psychosocial factors:

• Z63.0: Problems in relationship with spouse or partner.
• Z56.9: Unspecified problems related to employment.
• Z62.820: Parent-child relational problem.
• Z65.8: Other specified problems related to psychosocial circumstances.

Z-codes only support the primary diagnosis; they do not justify the claim alone. They provide context for the complexity of treatment and support higher levels of care when necessary. Insurance reviewers value comprehensive coding that captures the full clinical picture.

Use "unspecified" codes (F31.8/F31.9) only for truly unclear presentations, such as initial assessments with limited history or conflicting information. Most insurers expect you to specify the disorder type and current episode within 2-3 sessions. Document your clinical reasoning if continuing with unspecified codes beyond initial visits, explaining what additional information you're gathering to clarify the diagnosis.

Monitoring and Outcome Tracking

Systematic monitoring provides vital data for managing bipolar disorder effectively. Regular tracking helps identify patterns, predict episodes, and measure treatment response over time.

Key monitoring tools include:

• Daily mood charts: Track mood ratings (1-10 scale), sleep hours, medication adherence, and significant events. Both digital and paper versions work well if used consistently.
• Sleep logs: Record bedtime, wake time, total hours, and sleep quality. Changes in sleep patterns often precede mood episodes by days or weeks.
• Early warning sign checklists: Personalized lists of early symptoms specific to each client's pattern. Review these weekly during vulnerable periods.
• Standardized assessments: Use validated tools like the Young Mania Rating Scale (YMRS) for manic symptoms or the Montgomery-Åsberg Depression Rating Scale (MADRS) for depressive episodes.

Adjust your clinical formulation as longitudinal data accumulates. Initial presentations may suggest one diagnosis, but tracking patterns over months reveals the true bipolar nature. Document how emerging data influences your diagnostic thinking and treatment planning.

Treatment response documentation should capture:

• Changes in episode frequency and duration
• Severity reduction in manic or depressive symptoms
• Functional improvements in work, relationships, and self-care
• Medication effectiveness and side effects
• Psychotherapy intervention outcomes

Update ICD-10-CM codes based on monitoring data. A client coded as F31.7 (remission) might need recoding to F31.3 (mild depression) if mood charts show emerging depressive symptoms. This precision ensures appropriate care intensity and supports continued treatment authorization.

Key Takeaways

Accurate coding for bipolar disorder requires careful attention to capturing the current clinical presentation. Choose ICD-10-CM codes that reflect the specific episode type and severity level instead of defaulting to unspecified codes. Your documentation should clearly show the connection between observed symptoms, functional impairments, and the chosen diagnostic codes.

Effective assessment combines various data sources:

• Structured tools: Use validated instruments like the MDQ or CIDI to systematically evaluate bipolar symptoms.
• Collateral information: Gather observations from family members who can identify manic/hypomanic episodes clients may not recognize.
• Longitudinal tracking: Monitor mood patterns over time to distinguish bipolar disorder from other conditions with similar presentations.

Your clinical documentation must balance thoroughness with efficiency. Include specific behavioral observations, episode characteristics, and safety concerns while avoiding vague language. Update codes promptly as presentations change between episodes or move into remission, documenting your clinical reasoning for code changes.

Treatment integration remains key for optimal outcomes:

• Coordinate with prescribers: Maintain regular communication about mood changes and medication response.
• Implement evidence-based psychotherapy: Focus on psychoeducation, rhythm stabilization, and relapse prevention.
• Develop comprehensive safety plans: Address both manic and depressive episode risks.
• Monitor systematically: Use mood charts and sleep logs to track patterns and treatment response.

Insurance considerations shape documentation practices. Match your ICD-10-CM codes precisely to current symptoms, add relevant Z-codes for psychosocial factors, and ensure your notes support medical necessity. This alignment between clinical reality and administrative requirements helps secure appropriate reimbursement while maintaining quality care standards.