How does ICD-10 affect Mental Health!?
by Leigh-Ann Renz, 11.10.13 (revised 6.19.15)
First, a quick primer: ICD codes are used for diagnosis – they support the CPT billing codes that describe what action was taken. For example, the ICD-9 code for major depressive disorder (MDD), recurrent episode is 296.3; and this diagnosis code would support a CPT code of 90837, 60 minute psychotherapy session.
ICD-10 and Mental / Behavioral Health
It has been a very common misconception in the mental health community that DSM and ICD are two different things: we’ve heard from providers repeatedly “I don’t need to worry about ICD becauase I use DSM”. The DSM is simply a guide to picking the correct ICD diagnosis code(s): DSM codes are ICD codes. While the DSM-IV promoted ICD-9 codes, the DSM-5 promotes both ICD-9 and ICD-10 codes, to recognize the upcoming ICD-10 transition.
(Click here for details about how DSM, ICD and CPT codes interact for mental health.)
How does the transition from ICD-9 to ICD-10 affect you as a mental & behavioral health / substance abuse provider?
In May 2013, the DSM-5 was released, causing significant changes to mental & behavioral health diagnoses and generating huge political buzz. At the same time, a mandatory change in ICD codes is taking place: by October 1st, 2015, all healthcare providers covered by HIPAA (including mental & behavioral health) must convert to using the ICD-10-CM diagnosis code sets.
The US is one of the last industrialized countries to make the transition to ICD-10, even though it was published in 1990. The international adoption of ICD-10-CM should facilitate data comparisons to track disease and treatment data; it may also decrease the need for claim supporting documentation as it includes severity indicators (and morbidity details) within each code.
These changes to both DSM and ICD mean that mental health billing is changing significantly.
DSM-5 created sweeping changes in mental / behavioral health diagnosis: some codes were eliminated, others were introduced, and in many cases, the coding methodology itself was changed. The advantage that DSM-5 offers to the mental health community is that it lists both the ICD-9 and ICD-10 codes side-by-side, so that once a provider has integrated the DSM-5 coding changes, they are already somewhat practiced at ICD-10. While our industry has an additional burden of DSM-5 in addition to ICD-10, this burden actually gives us a head start in the ICD-10 changeover.
ICD-10 is expected to be a massive shift in healthcare coding: the approximately 11,000 diagnosis codes in ICD-9-CM are correlating with almost 68,000 codes in ICD-10-CM, increasing the detail available in each code and bringing the US in alignment with the current worldwide standard. This increase in volume in expected to create a bottleneck in claims, and experts are advising that practices have at least six months of cash reserves to weather the impending storm.
Remember the backlog of payments created for mental & behavioral health in January 2013 by the 5010 transition? ICD-10 is predicted to be more extensive in scope than any previous code updates. While it appears to be a valuable transition for healthcare, it certainly means a lot of work for those having to implement the switch.
Implementing an ICD-10 action plan is time consuming, but it’s essential
It’s easy in our often already-overloaded practices to put this necessary update on the backburner, but it’s vital to confront this challenge now. As of midnight on 10.1.15, any claims filed for dates of service on or after this date must contain ICD-10-CM codes. Because this is a HIPAA mandate, penalties for failure to comply will be enforced. Civil and criminal penalties may include heavy fines and imprisonment. Due to the scope of changes, this isn’t something that can be ignored or addressed last minute.
How do you get started? Check out the following ICD-10 tools & resources:
Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Resources
American College of Physicians ICD-10 Resource Center
AAPC Coding Books
PIMSY ICD-10 Resource Center
8 Steps to a Smooth ICD-10 Transition
2015 Compliance Guide (Part 3): ICD-10
ICD-10 Monthly Action Items Series
Disclaimer: Ultimately, it is the responsibility of each practice to ensure ICD compliance, including the 10/1/15 ICD-10 deadline. PIMSY EMR/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 EMR/SMIS assumes no responsibility for use of the information provided. Neither PIMSY EMR/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 medic al, legal, financial or other professional advice and readers are encouraged to consult a professional advisor for such advice.