[humanser] Clarity using the new ICD10 and the DSM V

[Paulette Vickery]

Hi all,

 

The information below is from an email I received earlier today. I think
that it helps demystify how and when to use the ICD10 codes along with how
to use the DSM V.

Paulette

 

"Understanding the ICD-10 Conversion

Industry Brief by Therapy Partner

Beginning October 1, 2015 All HIPAA Covered

Entities Must Utilize ICD-10 Codes

[ICD-10 Transition... What Does It All Mean?]

DSM-5/ICD-10 Transition...What Does It All Mean?

The DSM-5 is a Subset of the larger ICD-10 which since 1980 began including
all

medical and psychological conditions. Beginning October 1, 2015 all HIPAA
covered

entities must transition from DSM-4/ICD-9 codes to DSM-5/ICD-10 codes.

NOTE: If you own the current DSM-5 Diagnostic & Statistical Manual, or the
Desk Reference,

you are already prepared for the transition, the books include the new
ICD-10 codes,

and were published to assist clinicians in locating and converting codes.

Where Do I Find ICD-10 Codes In The DSM-5

To use your DSM-5 Diagnostic & Statistical Manual or Desk Reference manual,
simply

locate the diagnostic you wish to apply, but begin to use the codes in grey
[following

or to the right] of each diagnostic listed in your manual. Select your
"Principle

Diagnosis" first. Please note with the removal of the Multiaxial System you
now must

choose one primary diagnostic. The secondary and tertiary diagnosis should
be listed

in order of need for clinical attention.

Locating New Codes:

Below is an illustration taken from the DSM-5. The code on the right is an
ICD-10

code. Beginning October 1, 2015, HIPAA covered entities will need to utilize
the

code on the right.

[ICD Conversion Sample]

Diagnostic Coding Example:

Below is an illustration of a diagnostic coding difference utilizing ICD-10.

Previously:

DSM-4/ICD-9:

296.9 Mood DO NOS

Now:

DSM-5/ICD-10:

F34.8 Other Persistent Mood [Affective] Disorders OR

F39 Unspecified Mood [Affective] Disorder

Understanding The DSM-5 Single-Axis (vs. Multi-Axial) Coding System:

With the introduction of the DSM-5 the multiaxial system of coding
diagnostics was

removed. In most cases clinicians have stopped using the multiaxial system
in favor

of the new single-axis coding system. Using the DSM-5 clinicians still take
note

of the same mental, physical, and social considerations as under the
multiaxial system

to provide comprehensive assessments, they just go about it differently.

1. Ordering Diagnostics:

Individuals will often have more than one diagnosis, so it is important to
consider

their ordering. In the new DSM-5/ICD-10 the first diagnosis is called the
Principal

Diagnosis. In an inpatient setting, this would be the most salient factor
that resulted

in the admission. In an outpatient environment, this would be the reason for
the

visit or the main focus of treatment. The secondary and tertiary diagnosis
should

be listed in order of need for clinical attention. If a mental health
diagnosis is

due to a general medical condition, the ICD coding rules require listing the
medical

condition first, followed by the psychiatric diagnosis, due to the general
medical

condition.

2. Axis I-III Are Combined:

DSM-5 combines the first three axes into one that contains all mental and
other medical

diagnoses.

Doing so removes artificial distinctions among conditions, benefitting both
clinical

practice and research use.

3. Axis IV:

The current fourth axis, describing contributing stressors, is now
represented through

an expanded selected set of ICD-10 codes.

4. V & Z Codes:

V and Z codes provide ways for clinicians to indicate other conditions or
problems

that may be a focus of clinical attention or otherwise affect the diagnosis,
course,

prognosis, or treatment of a mental disorder (such as relationship problems
between

the patient and their intimate partner).

5. GAF Removal:

DSM-IV's previous fifth axis GAF was removed from DSM-5 due to its
conceptual lack

of clarity and questionable use in routine clinical practice. Instead, the
World

Health Organization's Disability Assessment Schedule, in which disorders and
their

associated disabilities are conceptually distinct and assessed separately,
is recommended

as a global measure of disability. This measure is based on an international
classification

of functioning and disability that is currently used throughout the rest of
medicine,

thereby bringing DSM-5 into greater alignment with other medical
disciplines."