The DSM-5 and ICD-10
By Barbara Griswold, LMFT
(October 6, 2014)
In May 2013, the American Psychiatric Association released the long-awaited major revision of our diagnostic Bible: The Diagnostic and Statistic Manual (DSM). The latest edition is called the DSM-5.
What’s new? Lots! Our favorite diagnostic tome has undergone some big changes.
The multi-axial diagnosis system has been dumped. You no longer have to think in terms of Axis 1 through 5. In fact, “the DSM-5 combines the first three… axes into one list that contains all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses,” says the American Psychiatric Association website. Contributing psychosocial factors and other reasons for visits are now represented through an expanded set of V-codes. There is no more GAF scale. Also, chapters have been reordered and diagnoses moved to different locations to group with similar disorders, and new categories and chapters (including a whole Trauma category). You’ll also note they dropped the Roman numerals in the Manual’s title.
Diagnosis changes: Changes have been made to many diagnoses, including the criteria for diagnoses you may use every day in your practice, so even if a particular code number hasn’t changed, be sure you check the symptom list carefully for changes. Controversial changes were made in the Autism realm, where Asperger’s has been eliminated, and several conditions have been collapsed into Autism Spectrum Disorder. Schizophrenia subtypes (paranoid, disorganized, catatonic, undifferentiated, and residual types) and Hypochondriasis have been eliminated. Panic disorder and Agoraphobia are now two separate diagnoses. Substance Abuse and Substance Dependence will be combined into a new diagnosis of Substance Use Disorder. And these are just a few of the changes.
New diagnoses: New diagnoses are plentiful, and include Disruptive Mood Dysregulation Disorder (designed to prevent the overuse of the Bipolar diagnosis with children), Premenstrual Dysphoric Disorder, Minor Neurocognitive Disorder, Binge Eating Disorder, Behavioral Addictions, Gender Dysphoria, Excoriation (Skin-Picking) Disorder, Genito-Pelvic Pain/Penetration Disorder (a merging of vaginismus and dyspareunia), and Hoarding – but you won’t find a diagnosis for sexual addiction. (Visit http://tinyurl.com/dsmchanges to view an excellent overview of the changes from DSM-IV to DSM-5 by the American Psychiatric Association).
“When should I start to use the DSM-5?” The American Psychiatric Association recommends that DSM users switch to DSM-5 if they have not yet done so already.
“Will these diagnoses be covered?” As I always say, remember that just because a diagnosis is in the Manual doesn’t mean it is covered. “Insurers are free to update and cover new diagnoses at their own discretion, which means some [diagnoses] may be slower than others to get put on their to-pay list,” says Jennifer Nelson of Insure.com. So before using a new diagnostic code, you or your client may want to contact the health plan to check that their system is updated and to check coverage of that code, and that the plan is ready to process claims with that code. As always, document and explain any diagnosis change in the client’s chart.
“The health plan asked for an ICD diagnosis. What’s the difference?” To make it simple, whenever you are using a DSM code, you are using an ICD code – that is, a code from the International Classification of Diseases. So if you are asked for an ICD diagnosis, don’t worry – you can use an up-to-date DSM.
“I heard that diagnosis codes are changing?” Yes, but here’s some good news: For each diagnosis in the DSM-5 you will see listed both ICD-9 CM codes for immediate use as well as the ICD-10-CM (in gray and parentheses, starting with the letter “F”), so you’ll be ready when the ICD-10 coding system comes. The diagnosis codes switchover to the ICD-10 that was supposed to happen October 1, 2014, has been postponed to October 1, 2015. Stay tuned to see if it is postponed again!
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Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should. To purchase the book or other resources for therapists, click here. Contact Barbara at firstname.lastname@example.org to get answers to your insurance questions.
Copyright 2008-, Barbara Griswold, LMFT. No part may be reproduced without written permission of the author.