By Sandra Varley, Ph.D., Practice-Makers.com
Everyone’s talking about it! I’m sure you are, too. On October 1, we switch over to DSM-5/ICD-10. The change will impact all of us. Are you ready?
Over the past several months, as I’ve been training mental health professionals throughout the state of Colorado on DSM-5 and ICD-10, clinicians have told me that they feel challenged to incorporate a completely new system into their work, and understandably so.
In the course of facilitating that transition for others, I’ve developed several tools to help aid in the challenge. Here are a few key strategies for avoiding the pitfalls of this new system:
1. Don’t assume that DSM-5 has everything you need.
It doesn’t. The ICD-10 codes found in DSM-5 do not include every ICD-10 code. The ICD-10 is much more specific in its coding structure than DSM-5. This is because the ICD-10 uses a number variation to correlate with the specifiers for many diagnoses, where the DSM-5 uses the general ICD-10 number for the diagnosis and then lists the specifier verbally.
For example, in DSM-5, the ICD-10 code listed for PTSD is actually only the OCD-10 code for PTSD, unspecified. ICD-10 has a total of three codes for PTSD: unspecified, chronic, and acute. Given that insurance typically doesn’t cover unspecified diagnoses, using only the ICD-10 code for PTSD from DSM-5 may result in claims being denied.
Therefore, always verify the ICD-10 code with an ICD source before finalizing it.
2. Don’t rely on “crosswalks” to give you the ICD-10 information you need.
These lists and indexes are crawling out of the woodwork now. If you’re curious, you can do a Google search on “ICD-10 code crosswalk”. While these may be helpful, they are only as good as the person who created them, so, don’t rely on them exclusively. They may or may not contain all of the ICD-10 codes or coding information we need.
This situation is also complicated by the fact that ICD 9 contained 13,000 codes, while ICD-10 has 69,000. There cannot be a one-to-one correlation between 13,000 and 69,000 items, so much interpretation exists about the translation from one to the other.
The better course of action is to use the ICD-10 itself. The so-called Blue Book of Mental and Behavioral Health Conditions which contains all the ICD-10 codes for mental health is available on-line for free download. Keep it handy and use it to verify the ICD-10 codes you are using. It’s clear and straightforward, and you’ll know you’ve got accurate and complete information there.
3. Avoid the confusion of diagnostic labels in DSM-5 not matching those in ICD-10.
The ICD-10 code number is what insurance companies and other decision-makers will use, so be sure that you have that number correct, even if your name label doesn’t match with the name of the condition in ICD-10.
For example, in DSM-5, the label Borderline personality disorder is paired with ICD-10 F60.3. In the actual ICD-10, the name that goes with F60.3 is “Emotionally unstable personality disorder”.
The ICD-10 further specifies two subtypes for this personality disorder: .30 Impulsive type and .31 Borderline type. In this case, if we use DSM-5, we would want to be sure to use either the ICD-10 F60.30 or F60.31 code with the “Borderline Personality Disorder” label, then include documentation verifying whether it was primarily impulsive or borderline in presentation.
Although insurance doesn’t reimburse for personality disorders, this is just one example of several diagnoses that are inconsistent and would likely be covered by insurance.
In summary, always get the ICD-10 code correct and then document the verbal descriptions and labels to support it. Again, be sure to verify both your ICD-10 number code and diagnostic label with ICD-10 itself, in order to minimize possible denials or difficulties.
4. Every insurance company will handle these codes differently.
Remember that insurance companies will be using ICD-10 codes to determine medical necessity in assigning claim payment. If you receive reimbursement directly from insurance, or if your client depends on that reimbursement for their therapy, check with the insurance as to what they will cover before you submit the claims. Make sure you have the correct ICD-10 codes, descriptive information and appropriate service codes to optimize insurance reimbursement.
5. Plan for the insurance bottleneck.
Most experts predict that insurance companies will not manage this transition well. As a result, we may not see payment of insurance claims for up to 60 days after Oct. 1. If your revenue stream includes direct payment from insurance companies, plan to be without that revenue for the next 60 days. If you haven’t done so already, make a contingency plan for the reduced income during this time.
Dr. Sandra Varley conducts training and case consultation for mental health professionals. For more information about her training resources, including mastering ICD-10, contact Dr. Varley at firstname.lastname@example.org or visit her website, www.practice-makers.com.