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On May 19, 2013, The APA released the DSM-5 to coincide with its annual conference in San Francisco. There was a bit of fanfare, nothing over the top, but enough to cause conversation among the clinician attendees. Since the conference, the Valant billing team has begun to field questions from some of our customers about how the new DSM-5 will impact their administrative and billing processes.

From a billing perspective, it is important to note the new DSM-5 code set is compatible with, and continues to rely upon, the current ICD code set, which is ICD-9. ICD-9 provides the medical community at large with the entire series of classified and available diagnostic codes used in all specialties. The DSM was created by the APA and is specifically used in the research and diagnosis of mental health conditions. The numeric codes contained in the DSM match those of ICD-9, but the verbal descriptions of those codes can vary between the two code sets. In fact, multiple disorders or conditions can be linked to a single numeric diagnostic code. As such, billers have always been tailoring the language connected to diagnosis codes to match the conditions their providers are commonly treating. In spite of the fact that the DSM 5 outlines some uncoupled conditions and has changed its approach in diagnostic assessments, it continues to interface with the ICD-9 code set. So billers will continue to update their practice management software diagnosis code descriptions to align with their provider’s practice.

The APA says that some insurance companies required claims to be reported along the multi-axial guidelines set by DSM-IV. The Valant billing team doesn’t have any experience with companies that had this requirement, so I’m not able to say what payers might make you change how you submit claims. However Medicare and Medicaid (and all commercial payers we’ve worked with) have used, and continue to use, a single axial system for claim reporting. From a practical perspective, this means not much should change about the way you send claims to payers for reimbursement. Billers will continue to send the numeric portion of a diagnostic code on claims. Providers will continue to state the verbal diagnosis (assessment) of their patient in their clinical notes.

CMS has a lovely FAQ which addresses a common concern we are hearing from our providers. Again, it is important to realize that although DSM 5 supplies a crosswalk to the upcoming ICD-10, the current ICD code set is ICD-9, and ICD-9 will be the code set that all specialties report from until October 1, 2014.

AUTHOR: Heather Grube