TheraManager LLC Announcement

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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.




Warm Regards & Good Weekend,


Russell Rothchild


TheraManager, LLC

TheraManager LLC

1 Gateway Center, Suite 2600

Newark, New Jersey 07102