2015 Compliance Guide (Part 2): DSM-5 / ICD-10
by Leigh-Ann Renz, 12.22.14
- DSM is ICD: it is a guide to picking the right ICD codes. You have been diagnosing in ICD, even though you may call it – or think of it – as DSM.
- You must use DSM-5, especially if you are reimbursed by Medicaid, Medicare, and/or insurance companies. (see * below for more info).
- The DSM-5 deadline is 1/1/14: you should be diagnosing with DSM-5 now.
- DSM-5 provides a different way to diagnosis than DSM-IV did, so you need to make sure you’re following the new guidelines. Sometimes they will point you to the same codes you’re used to using, other times, they won’t: DSM-5 added some new codes and deleted others.
- DSM-5 also lists both ICD-9 and ICD-10. Until 10/1/15, use the ICD-9 code. After 10/1/15, use the ICD-10 code (in parentheses).
DSM-IV provided several codes for Pervasive Developmental Disorder (PDD): 299.00 for Autistic Disorder, 299.80 for
Rett’s Disorder, Asperger’s and non-specified PDD, and 299.10 for Childhood Disintegrative Disorder. DSM-5 no longer includes codes 299.10 or 299.80: it is now all lumped under code 299.00 for ICD-9 (F84.0 for ICD-10).
As you can see from the description, diagnosing itself is different with DSM-5. Also, you will use 299.00 until 10/1/15,
then use F84.0 after 10/1/15 for this diagnosis:
- ICD is a diagnosis code set established by the World Health Organization (WHO) and used internationally: the US is the only industrialized nation to not yet move to ICD-10.
- You have always used ICD codes to diagnose, even if you call them or think of them as “DSM”. DSM-IV listed ICD-9 codes; DSM-5 lists both ICD-9 and ICD-10 codes. See screenshot + description above.
- The US will transition from ICD-9 to ICD-10 on 10/1/15. You need to use DSM-5 for diagnosis now, but use the ICD-9 code they provide until 10/1/15, then the ICD-10 code in parentheses after 10/1/15. See screenshot above.
Is PIMSY on top of DSM-5 / ICD-10?
Yes, we are! In fact, we have been somewhat of an industry front-runner in terms of ICD-10 preparedness. In addition, PIMSY EHR itself contains a fully electronic crosswalk from DSM-IV to DSM-5 and ICD-9 to ICD-10.
We’ve been talking about being ready for both ICD-10 and DSM-5 for years, and have entire Resource Centers on our website dedicated to these topics. We’ve also gone above and beyond for our clients, providing a fully electronic version of the DSM-5 in PIMSY itself to assist with correct coding!
While every practice is individually responsible for coding correctly, and there’s only so much we can do as an EHR vendor, we’re going above and beyond to educate and assist our clients with ICD-10 and DSM-5.
We also have tons of industry-relevant resources about topics such as HIPAA, PQRS, Meaningful Use, and much more. Rest assured that PIMSY is on top of the compliance issues you face as a provider and will help you stay ahead of the curve in this ever-changing landscape.
How Should You Proceed?
While we won’t tell you how or what to code, we do advise that you take the following steps to ensure coding & billing compliance:
1) Contact your payers! You should contact each of your payers, confirm the dates with them about when they will require DSM-5, and if there are any discrepancies, go over them. The most important thing is to figure out what they require to pay you.
You may have to explain to them what DSM-5 is, or remind them of the compliance date or talk to several people before you find someone who speaks your language. But it’s really important to invest the time to make sure you’re in compliance with your payers.
2) Make a list of your most frequently used DSM-IV codes: everything that you are used to using.
3) Look those diagnoses up in DSM-5: sit down and get cozy with that guide, and see how the diagnosis pathway and/or codes themselves may have changed.
4) Create a crosswalk as you go, making notes about what you find to share with your staff.
5) You probably want to leave the ICD-10 codes off for now, to avoid confusion. One solution is to create this crosswalk in a spreadsheet with columns for both ICD-9 and ICD-10, hiding the ICD-10 column for now. When it’s time to begin testing ICD-10 codes with your payers and training your staff on using ICD-10, you can then easily provide the correct corresponding ICD-10 codes.
6) Train your staff: conduct practice-wide trainings until your providers and billers are familiar with the changes and committed to implementing them. You can print the crosswalk created for easy office reference.
7) Check your RAs: of course, the best way to make sure you’re coding correctly is whether or not you get paid! Insurers and other payers should be requiring DSM-5 diagnosis, so be sure you’re checking (and double-checking) remittances to make sure the coding is being accepted.
8) Transition to ICD-10: whenever you are ready to begin testing with your payers for ICD-10, unveil those corresponding codes, and repeat the training process. Testing with payers will let you know when you’ve gotten it, and continuing to stay on top of remittances until the ICD-10 storm has passed is a great safeguard.
You’ll want to start testing ICD-10 codes with your payers in late spring of 2015 – or early summer at the latest! You’ll need the summer to make practice-wide corrections so you’re completely ready by 10/1/15.
For mental health, how do DSM, ICD and CPT interact?
Coding and Billing Resource Center
ICD-10 Resource Center
2015 Compliance Guide 2015 (Part 1): PQRS
2015 Compliance Guide 2015 (Part 3): ICD-10
2015 Compliance Guide 2015 (Part 4): HIPAA
*Although no one is going to put you in jail for not using DSM-5, you risk claims being rejected from payers – and it’s the accepted industry standard. Click here for more info: this article is focused on ICD-10, but the reasons apply to DSM as well).
(Disclaimer: Ultimately, it is the responsibility of each practice to ensure DSM-5 compliance. PIMSY EHR/SMIS has gathered information from various resources believed to be authorities in their field. However, neither PIMSY EMR/SMIS nor the authors warrant that the information is in every respect accurate and/or complete. PIMSY EHR/SMIS assumes no responsibility for use of the information provided. Neither PIMSY EHR/SMIS nor the authors shall be responsible for, and expressly disclaim liability for, damages of any kind arising out of the use of, reference to, or reliance on, the content of these educational materials. These materials are for informational purposes only. PIMSY EMR/SMIS does not provide medical, legal, financial or other professional advice and readers are encouraged to consult a professional advisor for such advice.)