|
NCPDP number
Dear
TheraManager Clients & Partners,
As always, we try to keep you updated on major industry
news. As you know, the adoption of ICD-10 was delayed, at minimum
until October 1, 2015. For all of us in Behavioral Health, that has
left open the question of when we will have to start using the DSM-5
diagnosis codes. The below APA article from yesterday helps to answer
this question. We will be sending out more information about DSM-5
soon.
Practitioners should continue using ICD-9-CM codes for billing
purposes
Despite some
insurer requirements to begin using DSM-5 for diagnostic criteria, the
ICD-9-CM is the only HIPAA-compliant coding system for billing purposes
until Oct. 1, 2015.
By
Practice Research & Policy staff
Optum,
an insurer under UnitedHealth Group, has sent notices to psychologists
participating with the insurer instructing them to begin using DSM-5 for
diagnostic criteria on Oct. 1, 2014. Even so, practitioners should continue
using ICD-9-CM codes for billing purposes until they are replaced by
the ICD-10-CM codes on Oct. 1, 2015.
The
official position of the Centers for Medicare and Medicaid Services (CMS)
is that ICD-9-CM is the only HIPAA-compliant coding system for billing
purposes. CMS defers to the American Psychiatric Association with respect
to using either the DSM-IV-TR or DSM-5 for diagnostic purposes. As of
January 2014, the American Psychiatric Association no longer considers
DSM-IV-TR a valid source for diagnostic criteria.
The
ICD-9-CM code set and ICD-10-CM code set, which will take effect in the
U.S. on Oct. 1, 2015, do not contain diagnostic criteria. While
practitioners could rely on the psychopathology literature, professional
guidelines or other sources, most providers use the DSM for diagnostic
criteria. If a health care professional uses the DSM for diagnostic
purposes, the American Psychiatric Association has said users should have
already switched to DSM-5.
Now it
appears the entities such as the VA along with Optum are also requiring use
of the DSM-5 for diagnostic guidance. For those using the DSM-5, two lists
of codes are provided in the manual. The numeric codes are the same as the
ICD-9-CM codes that psychologists have been using. The codes in parentheses
are the ICD-10-CM codes that will go into effect Oct. 1, 2015.
Practitioners
should be aware that some new diagnoses that appear in the DSM-5 were not
part of the DSM-IV-TR. For example, the new "Binge Eating
Disorder" in the DSM-5 has no analog in the DSM-IV, nor a unique code
in the ICD-9-CM. The ICD-9-CM code 307.51 is the code for Bulimia Nervosa,
but the American Psychiatric Association has cross walked Binge Eating
Disorder to 307.51 when using ICD-9-CM. Therefore, until the switch to the
ICD-10-CM takes effect, practitioners who use the new diagnoses in the
DSM-5 should be sure to document both the code and the name of the disorder
for clarity.
=============================================
http://www.apapracticecentral.org/update/2014/09-25/icd-codes.aspx
=============================================
Warm Regards & Good Weekend,
Russell Rothchild
CEO
TheraManager, LLC
|