Children with mental disorders - defined as "serious deviations from expected cognitive, social, and emotional development" - often have trouble learning in school, making friends, and building relationships later in life, the report said.

They are more likely to have other chronic health problems, such as asthma and diabetes, and are at risk for developing mental illnesses as adults.

"This is a deliberate effort by CDC to show mental health is a health issue. As with any health concern, the more attention we give to it, the better. It's parents becoming aware of the facts and talking to a healthcare provider about how their child is learning, behaving, and playing with other kids," Dr. Ruth Perou, the lead author of the study, told Reuters in an interview.

"What's concerning is the number of families affected by these issues. But we can do something about this. Mental health problems are diagnosable, treatable and people can recover and lead full healthy lives," Perou added.

The study cited data collected between 1994 and 2011 that showed the number of kids with mental disorders is growing. The study stopped short of concluding why, but suggested improvements in diagnoses as one possible explanation

"Changes in estimated prevalence over time might be associated with an actual change in prevalence, changes in case definition, changes in the public perception of mental disorders, or improvements in diagnosis, which might be associated with changes in policies and access to health care," the study said.

Perou told Reuters more research was needed to determine the specific causes of mental disorders, and that greater awareness could lead to an uptick in diagnoses. A host of environmental factors, including chemical exposure and poverty, can also affect a child's mental health, she said.

Lead, for example, is known to be "one of the biggest toxins to impact behavior and learning," Perou said. Poor children are at a higher risk for developing certain conditions, according to the study.

The most prevalent mental health diagnosis, as reported by parents, was Attention Deficit/Hyperactivity Disorder (ADHD), which affects 6.8 percent of children. Also common were behavioral conduct problems (3.5 percent), anxiety, which consists mostly of fears and phobias (3 percent), depression (2.1 percent) and autism spectrum disorders (1.1 percent). Many of these disorders occur together, the report said.

Boys were found more likely to have most of the listed disorders except for depression and alcohol abuse, which affect more girls.

The study also noted that suicide, which can be precipitated by an untreated mental illness, was the second leading cause of death (after accidents) among children 12 to 17 years old.

The CDC report was based on multiple other studies that collected data and interviewed children and their guardians about their diagnoses, habits, behaviors and other factors.

• Updated “Official ICD-10-PCS Coding Guidelines” with guidance from the ICD Cooperating Parties: CMS, the Centers for Disease Control and Prevention, the American Hospital Association, and the American Health Information Management Association
• The 2014 ICD-10-PCS code tables and index, which add four procedure codes created to capture new technologies

To find out more about the 2014 ICD-10-PCS files, see the accompanying “What’s New” document. The 2014 General Equivalence Mappings (GEMs) and 2014 Reimbursement Mapping files will be released in October 2013.

The FY 2014 ICD-9-CM procedure code files are posted on the Updates and Revisions to ICD-9-CM Procedure Codes website. There will not be any FY 2014 ICD-9-CM diagnosis files, as CDC is not updating ICD-9-CM diagnosis codes for FY 2014. 

Clarification on the Use of External Cause and Unspecified Codes in ICD-10-CM
Just as with ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting.  Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20, External Causes of Morbidity, is not required.  If a provider has not been reporting ICD-9-CM external cause codes, the provider will not be required to report ICD-10-CM codes in Chapter 20, unless a new state or payer-based requirement regarding the reporting of these codes is instituted.  Such a requirement would be independent of ICD-10-CM implementation.  In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies.

Sign/Symptom/Unspecified Codes
In both ICD-9-CM and ICD-10-CM, sign/symptom and “unspecified” codes have acceptable, even necessary, uses.  While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the health care encounter.  Each health care encounter should be coded to the level of certainty known for that encounter.

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis.  When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type).  In fact, unspecified codes should be reported when they are the codes that most accurately reflects what is known about the patient’s condition at the time of that particular encounter.  It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.

IMS Health reported other signs of contraction in healthcare use and spending in 2012:

• Nonemergency hospital admissions decreased by 0.5%, after falling 3.2% the year before.
• The volume of outpatient treatment slipped 0.6%; in 2011, it had risen by 0.1%.
• Total spending on prescription drugs decreased by 3.5% on a real per capita basis, reflecting in part a shift from brand-name drugs to generics, gentler price increases, and reduced spending on new drugs.
• Per capita use of prescription drugs fell by 0.1% compared with a 1.1% decline in 2011. A weak season for coughs, colds, and influenza in early 2012 was the biggest contributor to the latest decrease. "Changes in per capita use of prescription drugs could indicate either appropriate disease management or...self-rationing by patients," the report added.

Emergency department admissions, in contrast, exhibited significant 5.8% growth.

The numbers cited in the study fit the narrative of a healthcare industry that is not the runaway cost train of yore. Total US spending on healthcare in the public and private sectors rose 3.9% in 2011 for the third year in a row, the lowest rate of growth in the last 52 years, according to a recent study by the Office of the Actuary of the Centers for Medicare & Medicaid Services that was published in Health Affairs. CMS chalked up the swoon largely to the aftereffects of a recession that officially ended in June 2009.

On May 6, Health Affairs published another study asserting that the recession accounted for only 37% of the spending slowdown between 2003 and 2012. The study attributed another 8% to fewer people with private insurance coverage as well as some Medicare reimbursement cuts. What explains the rest of the slowdown, the authors state, could be long-term changes in how the healthcare industry operates. Some of these changes include slower development of new drugs and imaging technology, increased patient cost-sharing, and greater efficiency on the part of clinicians, hospitals, and other providers.

The outlook for physician office visits is not exactly clear, but there are hopeful signs. The CMS study of healthcare spending in 2011 showed that outlays for physician services increased by 3.6%, which is up from 2.8% in 2010 and 2.7% in 2009. The direction for office visits, as reported by IMS Health, is also promising: Visits declined by 4.2% in 2010 and 4.7% in 2011, but only by 0.9% last year.

The study found that patients with insurance paid higher deductibles, copays and co-insurance for their overall healthcare, but prescription drug copays for most patients declined. At the same time, new transformative medicines became available to treat a large number of diseases with small or strictly defined patient populations.

The report’s key findings include the following:

Changes in the utilization of healthcare services and medicines. The number of patient visits to doctors’ offices fell 0.9 percent in 2012, a lower level of decline compared with the prior two years. Outpatient treatment and non-emergency room admissions also were down slightly. Only emergency room admissions increased, by 5.8 percent, in 2012. Use of medicines per person declined slightly by 0.1 percent, partly due to a milder cough, cold and flu season in the initial months of 2012.

Healthcare costs and spending on medicines. The total cost of medicines declined by 3.5 percent on a       real per capita basis to $325.8 billion. In addition to lower utilization of branded drugs, the primary drivers were: the increased availability of  lower-cost generics, which now account for 84 percent of all prescriptions; the moderating impact of price increases; and lower spending on recently launched medicines. Healthcare costs remain heavily concentrated among relatively few patients suffering from multiple chronic conditions, cancer or other specialty diseases.

Patient payment for healthcare and medicines. Patients with insurance are paying higher deductibles and higher copays or co-insurance, with nearly 20 percent of the insured now in a consumer-driven health plan. Average out-of-pocket costs for commercially insured under age 65 patients reached $1,146 in 2012, a 30 percent jump from 2011 and entirely the result of higher deductibles. The average pharmacy benefit copay declined by $2 to $121 in 2012; patients filled 72 percent of all retail prescriptions with a co-pay of $10 or       less.

Transformations in disease treatment. Patients gained access to 28 new molecular entities in 2012, including seven with orphan drug designations by the FDA for rare diseases, a novel oral therapy for rheumatoid arthritis, a treatment for cystic fibrosis that will significantly improve life expectancy for patients with a specific genetic mutation, and an inhalable anti-psychotic. Nine new       cancer treatments were introduced last year, the most in more than a decade, including a breakthrough for treating basal-cell carcinoma.

To read the full report, please visit www.theimsinstitute.org.