Clinical Alert: Update on Billing with ICD-10

By Erica Kirsners

1. Use ICD-10 diagnostic codes for Dates of Service (DOS) October 1st and later.  Be sure to use ICD-9 codes for all DOS in September and ICD-10 codes for all DOS in October and later – no matter when you submit the claim.  (Therefore - if you submit a claim on 10/5 for a session on 9/28, use the ICD-9 diagnostic code.)
• Do not submit a bill on one CMS-1500 form that includes both DOS prior to 10/1 and DOS 10/1 or later.
• Use ICD-10 codes on requests for prior auths for DOS 10/1/15 and later. You do NOT need to submit a new auth request simply to change to the ICD-10 diagnosis if your current auth spans the 10/1 date.
• When submitting a CMS-1500 paper claim form: 
  Do NOT use the period in the diagnosis on a paper claim to Medicare or BCBS. 
  DO use the period when submitting a paper claim to Tufts.
• With online billing, continue to do what you have been doing for each particular insurance company.  
2. When submitting ICD-10 codes on the CMS-1500 paper claim form, be sure to change the “9” to “0” on line 21, "ICD Ind."
3. This change to ICD-10 and DSM-5 will have no effect on the CPT codes, keep using the same CPT codes   (90832: 16-37 min; 90834: 38-52 min; 90837: 53+ min).
4. The DSM-5 manual is very helpful. It lists all the ICD-10 codes (in parentheses, in gray) right next to the descriptive DSM diagnoses.


If you have not yet purchased it, NASW has acquired a 15 percent discount for its members through American Psychiatric Publishing. Use the discount code NASWMEM when ordering by phone, 800.368.5777 or online, www.appi.org/Home.  It is also available at http://www.valore.com/about-us/valorebooks/ and other places.

 

DSM-5 has several crosswalks from ICD-9 to ICD-10. 

- An alphabetical listing of all diagnoses with their ICD-9 (what we used to call DSM-IV) codes and ICD-10 codes; and

- A numerical listing of all the ICD-10 codes and their DSM-5 diagnoses.

 

5. Here is an easy online crosswalk to use - type in the ICD-9 code ("DSM" code) you are currently using, and the site gives you the corresponding ICD-10 code:
       http://www.icd10codesearch.com

 

6. Unfortunately, the published version of DSM-5 has some mistakes.  There is a correction sheet of the major changes on page 3 of the APA Coding Update
        http://dsm.psychiatryonline.org/pb/assets/raw/dsm/pdf/DSM-5%20Coding%20Update_Final.pdf




It appears that only 3 changes apply to the codes we generally use (most of the changes pertain to neurocognitive issues):


Bipolar I Disorder, hypomanic, in partial remission should be F31.71

Bipolar I Disorder, hypomanic, in full remission should be F31.72


AND, Adjustment disorders should now be specified in your client’s notes as ACUTE (less than 6 months) or PERSISTENT/CHRONIC (6 months or longer). 

 

Please note – ALL SPECIFIERS are noted in your chart only, not on the claim form.

 

There are a few other coding changes to check out, on pages 4-9:  Intellectual Developmental Disorder, Language Disorder, Selective Mutism, Trichotillomania, Insomnia Disorder, Hypersomnolence Disorder, Conduct Disorder, Adolescent-onset type, Kleptomania.

 

7. Most of the brouhaha over ICD-10 appears to be because the medical (not the psychiatric) diagnoses have mushroomed, and now necessitate a much greater degree of specificity.  ICD-9 had approximately 13,000 codes; ICD-10 has approximately 68,000 codes.  But the number of codes in mental health, about 700, has barely increased.