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ICD-10 and DSM-5: The Reality

January 29, 2014

The ICD-10 transition is proving to be a formidable challenge in the healthcare industry for everyone involved. Provider organizations need to train their clinical staff, worry about revenue cycle disruption,  and conduct internal and external testing with all parties. Third-party vendors such as Electronic Health Record companies are also struggling to keep up, with Meaningful Use Stage 2, 2014 Certification, and the ICD-10 transition. Fortunately, there are many trainings available to help you understand the what the ICD-10 transition involves. Unfortunately, most of these trainings are medically-focused, not given by those in the mental health or substance use industry, and they do not really explain how the DSM-5 fits into this transition.

Political controversy aside, our industry still relies on the DSM for now and we will have to become versed in the new DSM-5.  On October 1, when the ICD-10 code set is mandated to go-live, the reality is we will need to know both the ICD-10 and DSM-5 code sets. Do not be fooled: There are distinct differences between the code sets. There are substantially more ICD-10 codes for us to use than the DSM-5 contains. Gaps between the two sets and stark differences in the language used between the code sets leave us with decisions to make about clinical documentation and how we explain diagnoses to our consumers. One simple example is the use of the terms “abuse and dependence” in the ICD-10 for substance use: the new DSM-5 has removed those terms, so which is it? If the third-party payer requires prior authorizations to utilize the DSM on their treatment forms, but we must submit the ICD-10 diagnosis for reimbursement, how do we reconcile this clinical documentation difference?

The reality is that our industry still needs the DSM for now to help us with common language, concepts, continuity, and understanding of our consumers. Our industry has not embraced the ICD yet and the DSM is still the dominant diagnostic manual taught in graduate schools. We need ICD-10/DSM-5 trainings that  help us understand the relationship and differences between the two code sets, the applications for both, and the implications for an organization. Until you have that clarity, the ICD-10 transition will keep you, and your staff, confused.

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