By Michael Griffin, JD, LCSW,
Staff Attorney
September, 2015

Effective October 1, 2015, health care providers are required to discontinue using the ICD-9 coding system for billing purposes, and begin to use the codes which are provided by the tenth revision of the International Classification of Diseases, otherwise known as the "ICD-10". It would be unrealistic to expect any widespread change, including this one, to be problem-free, but generally speaking, this is not a difficult proposition and most clinicians should be able to accommodate to the change with minimal difficulty. In other words, an ICD-10 apocalypse is not imminent, and clinicians are urged to remain calm during the transition.

The Diagnostic and Statistical Manual of Mental Disorders (" DSM 5") was published by the American Psychiatric Association ("APA") in May, 2013. It provides the diagnostic criteria that is used by mental health professionals of every discipline in determining a mental health disorder. Clinicians will continue to use the DSM 5 for the purpose of determining a patient's diagnosis.

The ICD-10 is essentially a giant codebook, published by the World Health Organization, containing thousands of alpha-numeric codes which are intended to represent all illnesses and health conditions. The subset of ICD-10 codes, which concern mental health disorders, are used in billing procedures to indicate the mental health diagnosis of a patient.

In the DSM 5, there is an ICD-9 code, and an ICD-10 code listed for every diagnosis. For example, the ICD-9 code for an adjustment disorder with anxiety is the familiar 309.24. The corresponding ICD-10 code for an adjustment disorder with anxiety is F43.22, and it is found directly adjacent to the ICD-9 code, in parenthesis. (Clinicians should not include the parentheses or the decimal point when listing the ICD-10 diagnosis on a standard CMS-1500 insurance claim form. An adjustment disorder with anxiety would therefore be written as F4322.)

For most therapists, the transition from ICD-9 to ICD-10 codes will be no more difficult than the prior example. It is worth mentioning that there are some differences between the list of codes that are found in the full ICD-10 manual and the list of ICD-10 codes that are in the DSM. A little background may be helpful here: The ICD-10 has been in use around the world for over a decade while American healthcare professionals continued to use the ICD-9 as a coding system. When the APA created the DSM 5, it attempted to harmonize the various diagnostic categories with the ICD-10 coding system, but the harmonization is imperfect. For example, there are some codes and clinical terms found in the ICD-10 that are not found in the DSM 5. This is the exception rather than the rule however and there is an overwhelming correspondence between the ICD-10 codes provided in the DSM 5 and those that are listed in the full ICD-10 codebook.

Beginning on October 1, 2015, health care providers should stop using ICD-9 codes and begin using the ICD-10 codes that are provided in the DSM 5. Clinicians should take note of various helpful appendices in the DSM 5, such as a list of every DSM 5 diagnosis and the corresponding ICD-10 code, and side-by side comparisons of every ICD-9 code and its ICD-10 counterpart.

A complete list of the ICD-10 Codes can also be found on the Centers for Medicare and Medicaid Services website at https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html (Click on “Code Tables and Index”).