ICD-10 and DSM-V: What Does One Mean to the Other?

Note: This article I wrote for WEDI was published last Spring prior to the general release of DSM-V.  Update:  The DSM-V manual itself contains associated ICD-10 diagnosis codes.  This was not known at the time of writing the article last year.

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DSM-5 and ICD-10: What Does One Mean to the Other?

Submitted by Gina Park, Director of Consulting Services, Axiom Systems;

Co-Chair ICD-10 Coding and Translation SWG

Much of the focus of the conversation surrounding ICD-10 has been around the medical side of things—how the move from ICD-9 to ICD-10 will impact medical benefits, medical reimbursement, and medical claims processing.  What about our mental health counterparts?  While virtually all mental health benefits are adjudicated as medical claims, there a divergence in how these claims get coded that is worth a separate conversation in and of itself.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) is the prevailing diagnostic system used by U.S. mental health professionals for the purpose of classifying mental and behavioral disorders today.  DSM-IV is developed and maintained by the American Psychiatric Association (APA).  Although most American mental health professionals have been trained in practice to use DSM-IV, this is NOT the official diagnostic system recognized by the government as well as other payers.  ICD-9 is officially recognized diagnostic system in the United States for reporting all medical AND mental and behavioral health related issues and disorders.  All World Health Organization (WHO) member countries including the United States are required to collect and report health statistics to the WHO using ICD codes as the framework.  This supports the fulfillment of WHO’s mission as an agency of the United Nations to attain the highest possible level of health for all people.  Without the use of a common language, this kind of data comparison and analysis would be quite hard, if not downright impossible.

In 1979, the federal government required ICD-9-CM codes be used for Medicare inpatient diagnostic and procedural billing.  Prior to 1979, DSM codes were acceptable for use in both reporting and reimbursement purposes.  Since 1989, ICD-9-CM has the required coding system to report all outpatient treatment and services for Medicare patients.  Soon after, other payers followed suit.  ICD-9-CM then became the official coding system for diagnostic billing in the United States.  To help mental health professionals transition to using the ICD-9 code set, APA, AHIMA, and a division of the CDC, the National Center for Health Statistics (NCHS) have worked together to develop a coding system for DSM-IV based on ICD-9-CM coding conventions and guidelines.  This group collaborated to minimize incompatibilities to the two diagnostic systems without comprising clinical integrity.  The current similarity between the two coding systems is a deliberate result of this collaborative effort.  For instance, a psychiatrist may use the DSM-IV code 296.3 for recurrent depression.  This corresponds to the ICD-9 diagnosis code 296.3, major depressive disorder, recurrent episode.  Based on how a clinician records encounter data into the clinical record (through EMR or another workflow process), the mental health practitioner may not realize that the DSM-IV code used to diagnose the patient gets transformed into ICD-9-CM codes for billing and reporting purposes.  The DSM-IV code as seen by the mental health practitioner in the clinical record is transformed to the corresponding ICD-9-CM diagnosis code on the submitted bill.

DSM-IV TR (DSM, Fourth Edition, Text Revision) was published in 2000.  This update listed additional diagnostic information for each condition.  This version also provides a crosswalk from the DSM-IV TR diagnostic code to the most compatible ICD-9-CM diagnosis code.  Despite the similarity, significant differences remain in the included disorders, disorder names and definitions, as well as how the categories are organized.

In 1999, work commenced between the federal government and the APA on DSM-5.  This extensive overhaul attempts, much like in ICD-10, how modern day advances in understanding behavioral issues and disorders could be reliably diagnosed by clinicians and other practitioners in the field of mental health.  This lengthy development time can be attributed to the magnitude of the change including the addition of new categories such as learning disorders and behavioral addictions; and the elimination of the current categories of substance abuse and dependence and are to be replaced with the category addiction and related disorders.  After these categories were created, numerous clinical trials were performed in order to test field reliability.  Results were analyzed and resulted in a number of revisions to the DSM-5.

As of date, DSM-5 is slated to be published in May 2013.  CMS has indicated in previous ICD-10 National Provider Calls that the CDC and the APA are working closely together to ensure DSM-5 and ICD-10 are compatible in their ability to work together for the diagnosing and reporting of mental and behavioral health issues.

 

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