Tips for Therapists Making the Change to ICD-10
In case you didn’t know already, starting October 1st 2015, insurance companies will start using the ICD-10 system for diagnostic codes, rather than the ICD-9/DSM codes. For any Date of Service (not date of claim submission) Sept. 30th or before, clinicians will still need to use the DSM codes. But any claims submitted for dates of service Oct. 1st or later will be rejected if they are not ICD codes. If you are a clinician billing insurance, you need to make this change or else you will be soon running into a lot of problems with rejecte claims.
What’s the difference between the DSM and the ICD system? Do I still need both of them?
DSM is a diagnostic determination guide. It can be a resource in providing information needed to make an accurate diagnosis, but it is a ICD 10 diagnosis (not a DSM diagnosis) that we are to now assign clients. It should be noted that the DSM may not be the ONLY or definitive source in determining diagnosis. According to the APA, “Psychologists might access that content through the DSM or through other resources such as the professional literature, practice guidelines or other accepted sources [to determine appropriate diagnosis]”.
Can’t we just have a simple chart that converts our DSM codes to ICD 10 codes?
No. The DSM V is NOT synonymous with the ICD-10. There are MANY more codes in the ICD-10 than there are in either the ICD-9 (which is roughly equivalent to DSM-IV) or the DSM V. There are approximately 14,000 codes in the ICD-9 but more than 68,000 codes in the ICD-10 (though of course we mental health professionals will only use a small fraction of those codes). While most of the ICD-10 codes are in the DSM V, some of the more specific ones are not. So, psychologists can’t simply convert DSM codes to ICD-10 codes automatically. PTSD is a good example of why a simple conversion from DSM V to ICD-10 isn’t going to be accurate. The DSM-V only has a code for PTSD “unspecified” type, while the ICD-10 has diagnostic codes for both PTSD “Acute” and “Chronic” types that are not in the DSM-V.
How can I find the correct diagnosis?
In general, you can find the correct corresponding ICD 10 code for most of the DSM diagnoses listed in the back of the DSM V. However, there are some ICD10 codes that aren’t listed in the DSM V, as in the case mentioned above about PTSD. So you can’t just rely on the DSM. Instead, we suggest crosschecking your diagnosis using one of several “crosswalk” tools available online. Two such resources would be:
Need for specificity, particular in relation to substance use disorders
One factor accounting for the increased number of codes in the ICD-10 pertains to the number of specifiers for the different diagnoses in the ICD 10. This is especially true for the substance use disorders. The increased use of specifiers is a main difference many clinicians will need to become familiar with as they move forward using the ICD-10 system starting Oct. 1st. It is important to be as specific as possible in selecting ICD-10-CM codes — that is, when known, use the code structure to indicate severity or other meaningful diagnostic information. Try to avoid “unspecified” diagnoses, as plans may not reimburse for them — plans are looking for increasing specificity in diagnosis.
No More NOS – “Unspecified” versus “Other Specified” diagnoses.
When the DSM switched from IV to V, the NOS specifier was replaced with two options “Unspecified” and “Other Specified”. The ICD 10 also uses this distinction. “Other Specified Disorder” allows the clinician to specify the reason that the criteria for a specific disorder are not met (it is required to give reason(s) why the criteria are not met in the diagnosis field). An example of this would be other specified depressive disorder, short-duration depressive episode, 9 days.
“Unspecified Disorder” allows the clinician the option to forgo specification. This would be used instead of deferring a diagnosis when a client does not meet criteria AND the provider cannot specify due to inadequate info. This will likely not be an acceptable reimbursable diagnosis.
It has been suggested that when you have the choice between an “Unspecified” and “Other Specified” diagnosis and both seem equally valid, choose the latter, and document in the chart what criteria were not met for you to use another diagnoses of this category.
How do I diagnose substance use disorders with the ICD-10?
This is probably the biggest category of changes from the DSM to ICD-10 system. The APA has created a very useful step-by-step guideline for diagnosing substance use problems using the ICD-10 system that can be accessed here.
Author: Jenna LeJeune, Ph.D
Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.