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. This was a massive overhaul of a diagnostic coding system for healthcare professionals, the first of its kind in over 30 years. The shift in coding came about as a way to provide “diagnostic specificity” so that DSM-5 diagnoses have their own individual codes rather than sharing codes with older diagnoses.
Fast-forward two years and more changes are happening. The Center for Medicare and Medicaid Services (CMS) has made updates for the 2018 fiscal year, and these updates are scheduled to take effect on October 1, 2017. For mental health professionals, this means that some of the ICD-10 diagnostic codes that we use frequently on invoices, Superbills, and claims have changed as part of their annual update. Going forward you must use these codes in your documentation and billing regardless of your payer source.
ICD-10 codes are connected to DSM-5 diagnoses, and the updates being made are meant to provide more precision to the diagnoses being made by healthcare professionals. Unlike ICD-9 codes, the new codes, including the 2018 updates, require you to communicate more information with the code, or to separate it from another diagnosis that shares the same code.
For MFTs, the majority of this year’s changes are related to substance use disorders, including the use of tobacco. New codes have been added for clients in early or sustained remission, including each level of severity (mild, moderate, or severe). Different codes would be used for someone who is actively using alcohol as opposed to someone who is in remission. Diagnostic specificity, in this example, may determine how many sessions insurance will cover. If a diagnosis is misaligned with treatment type and frequency, one may face a treatment review. It is important to be as accurate as possible when diagnosing a client.
Apart from substance use disorders, the code for Avoidant/Restrictive Food Intake Disorder has changed from diagnosis code F50.89 to F50.82.
Here is a table of the ICD-10 updates for MFTs.