You may recall that on October 1, 2015 diagnosis codes changed from the 9th edition of the International Classification of Diseases and Related Health Problems ICD-9 to the 10th edition, also known as ICD-10. For the first time in over three decades, new codes were implemented for all diagnoses, and the total number of medical diagnostic codes increased five-fold—from approximately 13,000 to 69,000. In recognition of the enormous overhaul to this system and the adjustments that come with it, The Centers for Medicare and Medicaid Services (CMS) had allowed a grace period of a year, while also introducing additional codes to the repertoire.
As of October 1, 2016 these additional codes must be used in place of the old ICD-10 codes, or you will likely see your claims denied. In fact, the incorrect use of ICD-10 is going to affect significantly your practice and your reimbursement. And while CMS allowed a one-year grace period for incorrect coding, that period has ended and attention to proper coding and notation is the standard. Movement to ICD-10 coding requires everyone using the ICD-10 to be as precise as possible.
For mental health professionals, like marriage and family therapists (MFTs), the updates affect 14 mental health diagnoses and may extend beyond these in requiring tighter and more specific diagnostic processes. To view a list of the old and new codes, click here.
A number of ICD-10 codes have been updated so that new DSM-5 diagnoses have their own individual codes rather than sharing codes with older diagnoses. In essence, it should now be clearer which diagnosis you are giving when using a code. However, it is also important to note that these 14 codes will no longer match those in the DSM-5. Mental health providers should continue to use the DSM-5 to determine the correct diagnosis, but be sure to use the new codes for these 14 diagnoses.
Keep in mind that the interface between the DSM-5 and ICD-10 is such that the DSM-5 is meant to be a guide to help clinicians choose the correct ICD-10 code. And we all know that this can be tricky when a client presents with most, but not all, of the criteria for a particular diagnosis. Until now, such cases had been covered using “unspecified codes.” However, the current move toward specificity, along with the view that there are incongruities between the DSM-5 and the CMS code sets, discourages the use of unspecified codes when diagnosing clients.
What this means for your practice is that you need to be proficient when applying the DSM-5 to ICD-10. The impact of this change does not end at billing and coding. All clinicians are responsible for documenting their diagnostic and treatment services properly. Client records must contain adequate information to support any diagnostic (ICD-10) and treatment (CPT) codes that are applied to a given clinical encounter. And while it is true that the greater detail and specificity provided by ICD-10 make reimbursement more likely, good documentation is necessary for proper coding. Ultimately, we are responsible for diagnostic coding, and a good understanding of ICD-10 is at the core of being able to do that well.