This is the third in a series of communications on our readiness and your compliance as a provider for ICD-10 implementation.

Full implementation of ICD-10 will occur over the next four months, with an implementation date of October 1, 2015. This communication focuses on the relationship between the Diagnostic and Statistic Manual of Mental Disorders (DSM) and version DSM-V and the International Classification of Diseases (ICD) and the upcoming rollout of version ICD-10-CM.

The ICD-10 transition has led to some confusion about how the DSM-V diagnosis and ICD codes are related. It is important to understand the differences as your organization moves through the ICD-10 implementation phases.

DSM-V provides criteria for diagnosing mental disorders and additional information to help mental health practitioners determine an accurate diagnosis, similar to a textbook. ICD codes are codes for a particular diagnosis and contain no diagnostic criteria or other information. Providers record the ICD code for a particular diagnosis on health insurance claims and other forms. When the DSM-V was created, the authors were aware that ICD-10-CM would be implemented as the standard medical coding system for use in the United States on October 1, 2015.

DSM-V also provides the HIPAA-compliant ICD codes associated with each diagnosis found in DSM. When DSM-V was released in May, the American Psychiatric Association (APA) included both the valid and HIPAA-compliant ICD-9-CM and ICD-10-CM codes associated with each disorder so the diagnostic criteria and the HIPAA-complaint ICD codes could be found in one place.

A diagnostic title in DSM-V has two ICD codes for the diagnosis. The first is the ICD-9 code, effective until October 1. The second, in parentheses, is the ICD-10 code and is required beginning October 1. The DSM page snapshot featured below shows how this appears.

The following bullets clarify the key points of ICD-10-CM coding and implementation that are most relevant to clinicians serving people with mental illness, substance use disorder or intellectual or developmental disabilities. 

• The ICD-10-CM codes are alpha-numeric. In DSM-V, they are in parentheses within the diagnostic criteria box for each disorder. If there is only one ICD-10-CM assigned to a disorder, it is at the top of the criteria set.

• If more than one code can be assigned to a disorder, the codes are at the bottom of the diagnostic criteria box. This occurs when subtypes are coded.

• For disorders with more complex coding, coding notes and coding tables are provided at the bottom of the criteria box. The substance/medication-induced disorders, for example, have complex coding.

• For additional guidance, always check the bottom of the diagnostic criteria box for coding notes. The example below illustrates how, in schizoaffective disorder, if catatonia is present, an additional code for catatonia should be used and is provided in the coding note:

For information on ICD-10 preparation at Smoky, visit the ICD-10 Resources and Implementation page on the Smoky website and sign up for additional bulletins for information about claims and eligibility and enrollment.