PIMSY mental health EHR integrates the DSM-5
by Leigh-Ann Renz, 5.18.15
DSM-5 prepares Behavioral Health Practices for ICD-10 as well
As a mental / behavioral health Electronic Health Record and Practice Management software, PIMSY EMR has endorsed and integrated the APA’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).
While DSM-5 is not required by law, the ICD codes it endorses are; and DSM is the only industry-wide accepted standard of mental & behavioral health diagnosis, and is recommended by CMS.
DSM vs ICD
The most common misconception in mental health / substance usage is that DSM codes are different than ICD. This is not the case: the DSM is a guide to picking the correct ICD codes. Diagnosis codes in ICD format have been required, by law, by HHS, and by payers, for at least the past 20 years - and you have been using ICD codes, even if you thought of them as DSM. The DSM-IV promoted only ICD-9 codes; DSM-5 promotes both ICD-9 and ICD-10 codes.
DSM-4 vs DSM-5
The DSM-5 deadline was 1/1/14: DSM-IV codes and methods should have been retired then, including GAF axes. The DSM-5 changes many of the diagnosis pathways, eliminates some ICD-9 codes and includes the corresponding ICD-10 codes in preparation for the upcoming ICD-9 to ICD-10 transition. Click here for more information about the differences between DSM-IV to DSM-5 and here for our 2015 DSM Compliance Guide.
PIMSY mental health EHR offers a straight-forward crosswalk that you can filter to pick whichever code set you choose: this allows you to search for the ICD-9 codes included in DSM-IV and/or DSM-5. In addition, we have also embedded an electronic DSM-IV to DSM-5 crosswalk (created by Partners Behavioral Health Management) to help with the transition between commonly used codes, especially those ICD-9 codes that were eliminated by DSM-5 (for example, 313.89, reactive attachment disorder).
Implementation of ICD-10 codes
PIMSY mental health practice management software contains an electronic version of the DSM-5. This means that, not only are the ICD-9 codes correctly listed for DSM-5, it also means that the ICD-10 codes are already in PIMSY. The DSM-5 is itself a crosswalk of ICD-9 to ICD-10 codes, and this is subsequently included in PIMSY.
DSM-5 removes the multiaxial system, but clinicians still report medical conditions that the client self-reports or that the provider has obtained medical documentation for to verify its presence. In DSM-5, all conditions are listed in hierarchy from the most severe then down to the least severe – and severity is now determined by using the Level 1 and Level 2 Cross-Cutting Symptom Measures. “The principal diagnosis is indicated by listing it first, and the remaining disorders are listed in order of focus of attention and treatment” (DSM-5, p. 23)
Axis I-III: DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses.
Axis IV: Contributing psychosocial and environmental factors or other reasons for visits are now represented through an expanded selected set of V codes (ICD-9) or Z codes (ICD-10). The V/Z code can be used when it is more specific to the care being rendered than a psychiatric diagnosis.
Axis V: The GAF scale was previously used, in DSM-IV, to measure disability and functioning for determinations of medical necessity for treatment by many payers, and eligibility for short- and long-term disability compensation. Global assessment of functioning is still reported as it was on Axis V, but now using the World Health Organization’s Disability Assessment Schedule (WHODAS) in DSM-5 instead of GAF.
The WHODAS measures six patient domains:
> Cognition: understanding and communication
> Mobility: moving and getting around
> Self-care: hygiene, dressing, eating and staying alone
> Getting along: interacting with other people
> Life activities: domestic responsibilities, leisure, work and school
> Participation: joining in community activities
WHODAS Scoring: There are two basic methods for computing the summary scores for the WHODAS 2.0: a simple summed-based score, and a more complex method called “item-response-theory” (IRT)-based scoring. PIMSY EMR will be integrating the more concise simple scoring method. The scores assigned to each of the items—“none” (1), “mild” (2), “moderate” (3), “severe” (4), and “extreme” (5)—are summed; as a result, the simple sum of the scores of the items across all domains constitutes a final summation rating that is sufficient to describe the degree of functional limitations.
“The clinician is asked to review the individual’s response on each item on the measure during the clinical interview and to indicate the self-reported score for each item in the section provided for ‘Clinician Use Only.’ However, if the clinician determines that the score on an item should be different based on the clinical interview and other information available, he or she may indicate a corrected score in the raw item score box.
The average general disability score is calculated by dividing the raw overall score by number of items in the measure (i.e., 36). The individual should be encouraged to complete all of the items on the WHODAS 2.0. If no response is given on 10 or more items of the measure (i.e., more than 25% of the 36 total items), calculation of the simple and average general disability scores may not be helpful. If 10 or more of the total items on the measure are missing but the items for some of the domains are 75%–100% complete, the simple or average domain scores may be used for those domains.” (APA, Additional Scoring and Interpretation Guidance for DSM-5 Users)
Consider the below table comparisons to see how the same content is formatted in DSM-IV-TR multi-axial format versus DSM-5 dimensional format. Notice that all of the content is retained in both formats, but the sequencing of conditions is different, because in DSM-5 all conditions are listed in hierarchy from the most severe then down to the least severe – and severity is now determined by using the Level 1 and Level 2 Cross-Cutting Symptom Measures.
Sources / Resources
(Disclaimer: Ultimately, it is the responsibility of each practice to ensure coding compliance. PIMSY EMR/SMIS has gathered information from various resources believed to be authorities in their field. However, neither PIMSY EMR/SMIS - nor its employees - 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 its employees - 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.)