DSM-5, ICD-10, CPT : How Do You Make Sense of It All??
by Leigh-Ann Renz, 7.8.14
Mental and behavioral health care practices have an added challenge of updating from DSM-IV to DSM-5, in addition to the already confusing world of medical coding & billing. How do you know what codes to use – and when??
We continue to receive questions from PIMSY clients and leads about DSM: when to stop using DSM-IV – when to start using DSM-5 – if the ICD-10 delay means DSM-5 is also delayed, and the like. Here’s the skinny: according to the 2nd paragraph in this document, DSM-5 was to have been adopted on 1/1/14. And yes, that means you’re already supposed to be using it instead of DSM-IV. However, DSM-IV has not yet officially been retired by the American Psychiatric Association (APA), which of course creates confusion for providers.
See What is the DSM-5 implementation date for details.
As you’ve no doubt heard, the deadline for ICD-10 was extended by a year to 10/1/15. While this extension is causing many providers, vendors and practices to delay working towards this transition, it will be huge and does affect you as a mental / behavioral health care provider.
We’re encouraging people to use this extra time to prepare, not put off! See our ICD-10 Resource Center for details and how-to guides geared for substance abuse, psychiatry, and behavioral health care providers.
Did you know that the CPT codes for mental health changed effective 1/1/13? Yes, that’s January of last year. We’re still encountering people who are fighting with payers about their CPT codes, so it’s a good time to reiterate that many of the most common mental / behavioral health and psychiatry codes changed.
For general medicine, there is often a team of coders who take the provider’s diagnosis codes and translate them into the applicable CPT codes, helping to ensure that payers cover the services. However, many behavioral health care providers have to wear both hats and stay on top of all of the ever-changing code criteria. If you fall into that category, making sure that you’re using current CPT is critical: click here for details.
What’s the Difference Between DSM and ICD?
The DSM is a guide to picking the right ICD diagnosis code. This bible of mental & behavioral health diagnosis is also 1) the only industry-recognized guide in the US; and 2) the only one CMS recognizes. So, despite the recent political buzz and friction about DSM-IV vs. DSM-5; if you’re being reimbursed by Medicaid and/or Medicare, you gotta use DSM-5. Since it’s the industry standard, it can also create issues separate from Medcaid/care.
“But I don’t use ICD codes; I’ve always used DSM!” Actually, you have! DSM-IV guided you to the appropriate ICD-9 codes: although most providers call them “DSM-IV” or “DSM-5 codes”, they are in fact ICD codes. The 2 huge changes that DSM-5 presents are: 1) a new diagnosis pathway, with means inclusion of some ICD codes and the exclusion of others; 2) it lists both ICD-9 and ICD-10 codes.
In order to get paid, you need to use the correct ICD-9 codes until 10/1/15; then the correct ICD-10 codes after that 10/1/15 transition date. What are the “correct” diagnosis codes? DSM-5! It’s now in effect, and you should be using this updated version to reach your client diagnoses. Click here for more details.
Check out For Mental Health, how do DSM-5, CPT and ICD-10 codes interact? and our ICD-10 Resource Center for additional information.