How Does the ICD-10 Delay Affect DSM-5?
by Leigh-Ann Renz, 6.8.14
We recently received a great question from one of our blog readers: “Does this mean that we will not implement DSM-5 until 10/1/15 since the coding is directly tied to ICD-10? Are the insurance companies on board?”
The DSM-5 deadline is completely separate from ICD-10
ICD-10 should not be used until 10/1/15, but DSM-5 is in effect now. Here’s the thing to keep in mind: DSM is only a guide to picking the right ICD diagnosis codes. While we are used to thinking of them as separate codes – or using terms like “DSM-IV codes”, there are only 2 diagnosis code sets: ICD-9 and ICD-10. There are no actual DSM-IV or DSM-5 codes: DSM endorses certain ICD codes and provides a coding pathway to reach them for diagnosing your clients.
The biggest differences between DSM-IV and DSM-5 are: 1) DSM-5 may provide a different coding pathway (ie, different ICD codes) than DSM-IV did. It has endorsed ICD-9 codes differently, meaning that some codes you are accustomed to using have been excluded, while others have been newly or differently endorsed. 2) Whereas DSM-IV only used ICD-9 codes, DSM-5 includes both ICD-9 and ICD-10 codes.
But I don’t use ICD; I use DSM!
Wrong: DSM is ICD! While DSM-IV may may guide you to different ICD-9 codes than DSM-IV, it may take you to the same codes – it all depends on what your specialty is and what your most common codes are. But the pattern is still the same: DSM helps you determine which ICD diagnosis codes to use.
When Does DSM-5 Need to be Used?
DSM-5 has been in effect since 1/1/14 – see the 2nd paragraph here. This means that you should already be using it to diagnose. DSM-5 lists both ICD-9 and ICD-10 codes – ICD-9 is listed first, and ICD-10 is listed second in parentheses:
You should use ICD-9 codes (in this example, 305.00 for alcohol use disorder, mild) until 10/1/15. After 10/1/15, you should use ICD-10 codes (in this example, F10.10).
Are the insurance companies on board?
The insurance companies are on board with whatever CMS, HIPAA and other government agencies regulate! Since CMS has backed the APA regarding DSM, this means that payers will support using DSM-5 effective 1/1/14, and billing will be rejected if coded in ICD-9 for dates of service after 10/1/15. This means that if you continue using DSM-IV after 10/1/15, your claims will be denied.
The first thing we advise practices to do is to contact their payers and find out where they are with ICD-10. When can you begin testing ICD-10? Do they have resources available? If they tell you that they “require DSM-5 as supporting documentation”, proceed as normal: you now know that DSM-5 contains both ICD-9 and ICD-10 codes, so use DSM-5 to get to the correct ICD-9 codes until 10/1/15; then use ICD-10 after the 10/1/15 ICD transition deadline. You should plan on continuing to use DSM-5 until the APA releases the next version.
Which codes am I supposed to use…and when!?
ICD-10 Resource Center
How Do ICD, DSM and CPT interact for mental health?
Coding and Billing Resource Center
FAQ about DSM-5
Sign up for our newsletter, where we share updates about ICD, DSM and other compliance & coding issues here.