By Ernie Hood
Ready or not, as of October 1, 2015, all healthcare providers covered by HIPAA will be required to convert to ICD-10-CM diagnosis code sets. It’s a major change, but fear not! With the right preparation, the transition should be relatively painless for most mental and behavioral health practices.
ICD-10, the 10th version of the World Health Organization’s International Classification of Diseases and Related Health Problems, or ICD, was originally released in 1992, but it is just now being implemented in the United States, where the vastly outmoded ICD-9 remains in use. ICD-10-CM refers to Clinical Modification, the system used to allow individual countries to modify the system for their own needs and practices.
The update promises more efficient claims management, reduced requests for clinical information, and hopefully fewer claims rejected because of non-specific diagnoses. Where ICD-9 had 14,000 codes, ICD-10 has 68,000—a nearly five-fold increase. This will allow for far greater coding specificity. “The real benefit is that codes will communicate a lot more information about not only what the general disorder is, but the specific features of the disorder,” said Dr. Gary Gintner, an associate professor at Louisiana State University and past president of the American Mental Health Counselors Association. “And the beauty of it is that it may also help with reimbursement.”
DSM-5 and ICD-10-CM: Close, but not identical
Mental healthcare practitioners may not know it, but they have actually had access to ICD-10-CM codes since the adoption of DSM-5 in 2013. Each of the DSM-5 listings “crosswalks” to two ICD codes. The first, in bold type, is the ICD-9 code for the specific disorder; the second, in parentheses, is the ICD-10-CM code, which will become the code to be submitted as of the October transition. For example, the codes for posttraumatic stress disorder are 309.81(F43.10). The “F” refers to the fifth chapter of the ICD-10-CM, which covers mental and behavioral disorders. ICD-10-CM codes stretch out to as many as seven characters, accommodating the ability to refer to diagnostic subtypes of certain conditions and allowing greatly improved specificity.
For most users, the transition will be a simple matter of submitting the ICD-10-CM codes from DSM-5. But of course, as Gintner explained, it’s not cut-and-dried. “ICD-10 is an advantage, but it’s not state-of-the-art in terms of mental health knowledge, because of the era that it came out of,” he said. “So some of the new developments you see in DSM-5 will not be represented in the ICD-10 as the mapping is not perfect. As people begin to use these code numbers, they’re going to need to be a little more familiar with the ICD, because there are going to be some options available to them that they’re not aware of.”
To gain a basic, rudimentary understanding of the new system, Gintner recommends printing a copy of the ICD-10-CM Chapter 5 code numbers and names. “Once you do that, you’ll have a sense of what the chapter really looks like and what you’re really doing,” he said. “You’ll also see that there will be codes that are not listed in the DSM that could be valid codes that you can use.” He also suggests taking advantage of the many ICD-10-CM webinars or other professional development training opportunities currently available, some of them specifically designed for mental health professionals.
Once you’re acclimated to ICD-10-CM, it will soon be time to get ready for the transition to ICD-11, which WHO is working on now. Fortunately for the mental health community, it should be much more closely harmonized with DSM-5, as both documents will reflect contemporary mental health thinking and practices.
For those who are intimidated by the approaching transition, here are additional resources to help: