There has been much confusion over the DSM-5, ICD-9, and ICD-10 codes. In order to clarify and answer questions, Dr. Arnie Schuster, President of DocuTrac, Inc. has written an article about these changes, as well as how the codes have been integrated into QuicDoc EMR Software.
The introduction of DSM-5 has been a major event and for some, a painful change, after decades of reliance on and familiarity with DSM-IV (DSM-IV-TR) codes.
Perhaps the most significant change with DSM-5 has been the movement away from the multi-axial system to document diagnoses – using Axis I, II, III, IV and V. So, when making a diagnosis now, all conditions relevant to assessing and managing the patient are listed together.
While there are many other changes with DSM-5 such as planning for ICD-11, developmental and lifespan considerations, new diagnoses and the omission of diagnoses or categories of diagnoses (e.g. elimination of Schizophrenia Subtypes which are now noted as specifiers), I would like to focus on changes involving the use of codes and descriptions.
Using ICD Codes
Early on in my career I recall submitting claims on HCFA-1500 forms and specifying DSM when entering diagnostic codes in Block 21. At the time you could choose to use DSM or ICD coding. And, in some cases, codes and their associated descriptions differed between DSM and ICD. In some cases, adding to confusion, in DSM the same code could be used for more than one description (e.g. 300.7 for Hypochondriasis and Body Dysmorphic Disorder). This has long since changed so that payers required ICD codes to be submitted. With that change, DSM came into more conformance with ICD coding. While that was a welcome change from the perspective of a vendor providing documentation and billing software, we were still challenged with mapping between two distinct structural approaches to making a diagnosis. On the Behavioral Health side, clinicians were making multi-axial diagnoses separating Psychiatric Disorders, Personality Disorders and Mental Retardation, and relevant Physical Conditions and Disorders. On the billing side, payers required ICD coding with primary, secondary, tertiary, etc. diagnoses.
With the elimination of the multi-axial system in DSM-5, that challenge has been eliminated. As significant as that change was there was also a shift in coding systems – the official coding system in DSM-5 is the ICD-9. While in some cases the name or description of the disorder may differ (e.g. 299.00 Autistic disorder (ICD-9) versus Autism Spectrum Disorder (DSM-5), the code used is the official ICD-9 code required for submission of a claim.
At DocuTrac, our primary emphasis in addition to preparing for DSM-5 was the (then) upcoming October 2014 deadline for the use of ICD-10. In an eleventh hour decision by congress, the ICD-10 was delayed until Oct 2015 – to the dismay or relief of many, depending on your perspective. In any event, DocuTrac was prepared for ICD-10 and in its latest versions of QuicDoc and Office Therapy® we included both ICD-9 and ICD-10 coding and mapping.
We are aware that many clinicians prefer the DSM Description or Names to the ICD-9/10 Descriptions. The structure and functionality is in place in the latest version of QuicDoc to allow the user to provide the equivalent DSM name. Our next release will allow the user the option to show on print-outs, the DSM or ICD Name, if different.
As we keep up with the ever changing requirements in a very dynamic profession, DocuTrac will do it’s best to provide easy to use, intuitive, and up-to-date functionality to meet your needs. This includes the driving forces behind Meaningful Use and for many, another coding system hitting the radar – SNOMED-CT. Stay tuned for more on SNOMED later.
Dr. Arnie Schuster
President, DocuTrac, Inc.