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Schizophrenia or other primary psychotic disorders is the Parent diagnostic category for all primary psychotic disorders and their symptomatic manifestations, hence ranging from 6A20 to 6A25 and also including ‘Other specified‘ or ‘unspecified‘ categories 6A2Y and 6A2Z. The two other categories in pale grey are belonging to secondary psychotic disorders (6E61) or substance-induced psychotic disorders (with their many different subcategories) whose parent are either ‘Secondary mental or behavioural syndromes associated with disorders or diseases classified elsewhere‘ or ‘Disorders due to a specific substance‘ (e.g., due to use of alcohol, 6C40) listed in the respective other chapters.
The 6A25 Symptomatic manifestations of primary psychotic disorders are the symptom qualifiers on positive, negative, depressive, manic, psychomotor and cognitive symptoms as mentioned in the Coding Notes of the MMS: These categories should never be used in primary coding. The codes are provided for use as supplementary or additional codes when it is desired to identify the presence of these symptoms in primary psychotic disorders.
According to a Description (which accompanies each category in the MMS): These categories may be used to characterize the current clinical presentation in individuals diagnosed with Schizophrenia or another primary psychotic disorder, and should not be used in individuals without such a diagnosis. Multiple categories may be applied. Symptoms attributable to the direct pathophysiological consequences of a health condition or injury not classified under Mental, behavioural or neurodevelopmental disorders (e.g., a brain tumour or traumatic brain injury), or to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, should not be considered as examples of the respective types of symptoms.
As can be seen in the MMS, to each of the primary psychotic categories all the symptom qualifiers can be added and also ranked for severity into mild, moderate or severe. By so-called ‚post-coordination‘, the ICD-11 Coding Tool then automatically adds this to a code string allowing for complex coding recognizing the patients individual dimensional symptom spectrum in addition to the diagnostic category: accordingly, the string for schizophrenia with severe positive symptoms the code string would be 6A20/6A25.0&XS25. All symptom qualifiers could be added here as well as the course specifiers (see S32), giving a much more individualized clinical picture than the diagnostic category alone.