|ICD-10 Required On October 1, 2015: Here’s What You Need To Know|
Beginning on October 1, 2015, clinicians will be required to use the ICD-10 codes when filing in and out of network insurance claims. All dates of service on or after October 1, 2015, should be coded with the ICD-10. For dates of service prior to October 1, use the ICD-9 codes. (The date of claim submission is irrelevant.)
No one should be using the old DSM-IV codes; if you’ve been using old DSM-IV codes and they’ve been accepted, consider yourself lucky - but don’t count on your luck lasting! Using the old DSM-IV codes without being familiar with the new diagnostic descriptions puts you at risk if your practice is ever audited. And with the advent of the ICD-10, those few old DSM-IV codes that were the same as the ICD-9 codes won’t work anymore; the new ICD-10 codes contain a letter prefix.
Where to find the new ICD-10 codes? Look in your DSM-5, on the first page of the relevant diagnosis, just below the diagnosis name; the second code listed - the one that’s grayed out, in parentheses, and begins with a letter - that’s the ICD-10 code. The one to the left of it is the ICD-9 that you should be using now, and through the end of September.
You may wondering whether you really need to purchase (or have ready access to) the DSM-5. The answer is yes! Here’s why:
The DSM-5 has changed in a number of significant ways such that you cannot rely on the old DSM-IV for diagnosis. While some of the old DSM-IV codes were identical to the ICD-9 codes, this will no longer be the case with the advent of the ICD-10. Some of the DSM-IV codes are no longer in use, and have been replaced by new ICD diagnostic codes, now required by all insurance companies. And in some cases an old diagnosis (with an old name and perhaps even an old diagnostic code) may have new symptoms and other criteria that you, as a clinician, are responsible to know. Using old, outdated DSM-IV codes could result in claim denials and possibly more complicated and problematic repercussions; for example, a retrospective audit might determine that the diagnosis you used is not substantiated in your record if your record does not reflect the current DSM-5 diagnostic criteria, resulting in the insurance company or Medicare demanding your repayment of insurance money paid. Please be sure that you are using the current DSM-5 and ICD codes to avoid problems!
A good resource for additional info about the ICD codes is http://www.psychiatry.org/psychiatrists/practice/dsm/icd-10