Understanding the ICD-10 Conversion

From Therapy Partner

To help you with the transition from ICD-9 to ICD-10 (required as of 10/1/2015), Therapy Partner has shared the following Industry Brief and resources:

Understanding the ICD-10 Conversion

DSM-5/ICD-10 Transition…What Does It All Mean?

The DSM-5 is a subset of the larger ICD-10, which since 1980 began including all medical and psychological conditions. Beginning October 1, 2015 all HIPAA covered entities must transition from DSM-4/ICD-9 codes to DSM-5/ICD-10 codes.

NOTE: If you own the current DSM-5 Diagnostic & Statistical Manual, or the Desk Reference, you are already prepared for the transition, the books include the new ICD-10 codes, and were published to assist clinicians in locating and converting codes.

Where Do I Find ICD-10 Codes In The DSM-5?

To use your DSM-5 Diagnostic & Statistical Manual or Desk Reference, simply locate the diagnostic you wish to apply, but begin to use the codes in grey [following or to the right] of each diagnostic listed in your manual. Select your “Principle Diagnosis” first. Please note with the removal of the Multiaxial System you now must choose one primary diagnostic. The secondary and tertiary diagnosis should be listed in order of need for clinical attention.

Locating New Codes:

Below is an illustration taken from the DSM-5. The code on the right is an ICD-10 code. Beginning October 1, 2015, HIPAA covered entities will need to utilize the code on the right.

ICD-10 Example

Diagnostic Coding Example:

Below is an illustration of a diagnostic coding difference utilizing ICD-10.

ICD-10 Example

Understanding The DSM-5 Single-Axis (vs. Multi-Axial) Coding System:

With the introduction of the DSM-5 the multiaxial system of coding diagnostics was removed. In most cases clinicians have stopped using the multiaxial system in favor of the new single-axis coding system. Using the DSM-5, clinicians still take note of the same mental, physical, and social considerations as under the multiaxial system to provide comprehensive assessments, they just go about it differently.

Ordering Diagnostics: Individuals will often have more than one diagnosis, so it is important to consider their ordering. In the new DSM-5/ICD-10 the first diagnosis is called the Principal Diagnosis. In an inpatient setting, this would be the most salient factor that resulted in the admission. In an outpatient environment, this would be the reason for the visit or the main focus of treatment. The secondary and tertiary diagnosis should be listed in order of need for clinical attention. If a mental health diagnosis is due to a general medical condition, the ICD coding rules require listing the medical condition first, followed by the psychiatric diagnosis, due to the general medical condition.

Axis I-III Are Combined: DSM-5 combines the first three axes into one that contains all mental and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting both clinical practice and research use.

Axis IV: The current fourth axis, describing contributing stressors, is now represented through an expanded selected set of ICD-10 codes.

V & Z Codes: V and Z codes provide ways for clinicians to indicate other conditions or problems that may be a focus of clinical attention or otherwise affect the diagnosis, course, prognosis, or treatment of a mental disorder (such as relationship problems between the patient and their intimate partner).

GAF Removal: DSM-IV’s previous fifth axis GAF was removed from DSM-5 due to its conceptual lack of clarity and questionable use in routine clinical practice. Instead, the World Health Organization’s Disability Assessment Schedule, in which disorders and their associated disabilities are conceptually distinct and assessed separately, is recommended as a global measure of disability. This measure is based on an international classification of functioning and disability that is currently used throughout the rest of medicine, thereby bringing DSM-5 into greater alignment with other medical disciplines.

To Learn More About The October 1, 2015 Transition to ICD-10 Codes or The DSM-5 Single-Axis Coding System Visit These Resources:

Guide to DSM-5 Transition to ICD-10

Changing The DSM Multiaxial System: From Division to Integration

VIDEO – Using DSM-5 In The Transition To ICD-10

Therapy Partner

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