DSM-5 and ICD-9 and ICD-10 are related, but not the same: the DSM provides diagnostic criteria, to which the ICD billing codes are then applied.
The DSM-5 manual contains descriptions of diagnoses of various behavioral health conditions. The numbers listed next to each diagnosis in the new DSM book are the ICD codes; there are no longer any “DSM codes.”
In the DSM-5 manual, the numbers in bold print next to each diagnosis are ICD-9 codes; the numbers in (gray) and within parentheses are the new ICD-10 codes.
Many – but not all – of the ICD-9 codes are the same as the old DSM-IV codes that have been used for billing purposes for many years. Therefore, the codes you are using will probably not change. However, it is important that you verify that there is no difference between the old DSM-IV code and the ICD-9 code. Search “crosswalk DSM-IV to ICD-9” to ensure that the code you want to use has not changed.
Always and only use the ICD-9 codes for billing purposes until October 1, 2015.
Always and only use ICD-10 codes after October 1, 2015.
There are over 100 DSM-5 diagnoses that share ICD-10 codes. For example, F508 will be used if the patient has either a Binge Eating Disorder, or Avoidant/restrictive food intake disorder, or Pica.
The “V” codes from DSM-IV now generally map to new “Z” codes.
The DSM-5 is a diagnostic manual developed by the American Psychiatric Association, published in 2013. Its focus is clinical – to list the symptoms which substantiate the presence of a behavioral health condition.
ICD-10 is a “disease classification system,” which was developed by the World Health Organization (the public health arm of the United Nations) to aid with policy and funding; it was published in 1992. Most countries adopted it for billing purposes in the 1990’s.
As CMS (the US Government Centers for Medicare and Medicaid Services) states:
Neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2015, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.
Continue to use the ICD-9 diagnostic codes until October 1, 2015; after that date, only use ICD-10 codes.
One must use only the new CMS-1500 (02/12) billing form for paper claims as of April 1, 2014.
CPT codes indicate the type of service we provide in each session (for example, use 90834 for a 38-53 minute individual therapy) and go in Box 24D on the claim form.
The information above was originally published in the September 2014 FOCUS newsletter.
< Back to Insurance / Managed Care
Author: Erica Kirsners, LICSW; Private Practice; Chair, SWTRS Commission; Member, HMO-MCO Commission.