Using DSM-5 in the Transition to ICD-10

Using DSM-5 in the Transition to ICD-10

Effective October 1, 2015, HIPAA-covered entities must use ICD-10 codes. The following information and guidelines help with the transition to ICD-10 using DSM-5.

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A Brief Guide to Using DSM-5 in the Transition to ICD-10

What is the relationship between the codes in my DSM and ICD codes?

Since 1980, every code that has been listed in DSM has been an ICD-9 code. However, DSM-5, unlike previous versions of DSM, contains both ICD-9 and ICD-10 codes. For most behavioral health providers, if you have a DSM-5, you are ready for the transition to ICD-10 on Oct. 1, 2015.

Where do I find the ICD-10 codes in DSM-5?

Below is an illustration taken from the DSM-5. The code on the left is an ICD-9 code. The code on the right is an ICD-10 code. As of Oct. 1, 2015, you must use the code on the right.

ICD-1.jpg

Since ICD-10 has more codes than ICD-9, how do I code disorders that now have multiple coding options?

Part of the reason the United States upgraded to a newer version of ICD is because it allows providers to be more specific in their diagnoses. For example, there is only one ICD-9 code you can use to diagnose anorexia nervosa. The code is 307.1. ICD-10 provides a unique code for the two types of anorexia nervosa—the binge-eating/purging type and a separate code for the restricting type. With ICD-10, you can now be more specific by assigning a different code for each type.

ICD-2.jpg

Here is an excerpt from a page of DSM-5 to show what these more specific codes look like in the classification:

ICD-3.jpg

Do I use the ICD-10 codes in claim forms I’m submitting now for patients I’ve seen before October 1st?

No. If you saw the patient on or before September 30th, use the associated ICD-9 code in your claim form, even if you submit the claim after October 1st. For any patient you see on or after October 1st, you will need to use the ICD-10 code in your claim form.

If I have DSM-5, do I need to purchase an ICD-10 to identify correct billing codes?

No. If you are a behavioral health provider, DSM-5 should remain your primary resource. It is a tool that provides you with diagnostic criteria and corresponding ICD-10 codes.

Do I need DSM-5 to practice, or can I just use the ICD-10 book?

Providers should continue to use DSM-5 to determine the correct diagnosis of a mental disorder. ICD-10 does not contain information to help guide diagnosis; it is simply a listing of disease names and their corresponding codes. There is a diagnostic book, The ICD-10 Classification of Mental and Behavioural Disorders (referred to as the “Blue Book”), which contains diagnostic criteria and non-U.S. ICD-10 codes. However, this book was last updated in 1992 and is not in line with contemporary thinking about mental illness in the same way as DSM-5.

Does the U.S. officially recognize DSM-5 for use in identifying ICD-10 codes?

Yes. The National Center for Health Statistics and the Centers for Medicare and Medicaid Services (CMS) are overseeing the official implementation of ICD-10 in the United States. CMS has posted the following on its website:

DSM-5 contains the standard criteria and definitions of mental disorders now approved by the American Psychiatric Association (APA), and it also contains both ICD-9-CM and ICD-10-CM codes (in parentheses) selected by APA. Since DSM-IV only contains ICD-9-CM codes, it will cease to be recognized for criteria or coding for services with dates of service of October 1, 2015, or later. Updates for DSM-5 criteria and their associated ICD-10-CM codes (identified by APA) can be found at www.DSM5.org.

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Notes

  • Throughout this document, we use the terms ICD-10 and ICD-9 for readability. These actually refer to the U.S. versions of the publications,known formally as The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
  • When “you” is used in this publication, we are referring to health care providers. Insurers and coders may require additional resources to prepare for the transition.