The DSM-5 came out in 2013 and some of us are still getting used to changes in some of our frequently-used diagnoses. Well hang on, because all diagnosis codes are changing on October 1. This shift affects both network providers and out of network providers.
A Little Context
Think of DSM codes as one section of an extensive list of all medical diagnoses called the International Classification of Diseases (ICD). So if you are asked for an ICD diagnosis, don’t worry – you can use a DSM code and it will be the same.
Right now, the DSM codes we are using are from the ICD-Ninth Edition, or ICD-9. But these codes are changing to a new code set, the ICD-10. This change means that for all session dates October 1, 2015 and after, insurance plans will require ICD-10 code numbers for the same diagnoses we’ve been using.
The new codes are completely different than the current ones we use.
But here’s some good news. For each diagnosis in the DSM-5, you will see under the name of the diagnosis listed both ICD-9 codes (for use prior to October 1) as well as the ICD-10 codes (in gray and parentheses, starting with a letter) for use starting October 1, so you’ll be ready when the transition takes place.
Remember: Do not use both ICD-9 and ICD-10 codes on the same claim form.
What This Means for the Claim Form
When coding diagnoses on the CMS-1500 claim form after October 1, you will put the new diagnoses in Box 21 as you currently do. However, in the upper right-hand corner of Box 21 where it asks for ICD-Ind (ICD Indicator), starting in October you should put a “0” (not a “10”) where you currently put a 9 — just before the vertical dashed line.
It may be time to shell out for your DSM-5 if you haven’t already. You can get your copy from the American Psychiatric Association or from Amazon.com. (Save money by ordering the paperback).
Frequently Asked Questions
“Are the diagnoses changing, or just the code numbers?”
The diagnoses themselves and criteria won’t change, just the codes numbers.
“What if I submit claims after October 1 for sessions prior to October 1?”
Use ICD-9 codes for dates of service prior to October 1 and ICD-10 codes for sessions October 1 and after.
“What if I am billing for some sessions prior to October 1 and some afterwards?”
Use one claim for pre-October dates of service and one for those October 1 and after.
“Why are you telling us so early?”
I plan to repeat this news as often as I can before the changes happen, to reach as many therapists as possible before this change. Otherwise, this fall, claims and super bills are going to be rejected by insurance plans, requiring resubmission and delayed payment.
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Swirl of numbers image available from Shutterstock