Unlike DSM-5, which is solely utilized for mental diseases, ICD-10 is only used for inpatient claims after a diagnosis has been made (Healthcare BPO, 2021). ICD-10 also distinguishes between dependency and substance abuse, although DSM-5 does not. General pertinent information about a patient's previous psychiatric and substance use, abuse, and treatment, psychosocial history, suicide/homicide risk assessment, mental status examination, clinical impression, abnormal findings, external causes of injury, social circumstances, and complaints is required for DSM5 and ICD-10 coding to be supported in documentation (Nathan, 2021) Pertinent Information missing from the given case study The DSM-5 is primarily concerned with assisting healthcare providers in correctly primarily intended to assist with billing and payments. The patient in this instance is a 25- year-old Russian woman who was recommended for psychiatric examination by her retiring practitioner for stimulant use problem, PTSD, ADHD, and is currently in remission. The patient's past psychiatric and substance use, abuse and treatment, psychosocial history, suicide/homicide risk assessment, mental status evaluation, and clinical impression have all been included in the case scenario. However, there is no documentation of the patient's aberrant findings, external causes of harm, social circumstances, or complaints. Including information about these four in the documentation will assist in narrowing the coding and billing possibilities
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