First it was Oct. 1, 2013. Then Oct. 1, 2014. Now it's Oct. 1, 2015. Though the deadline for implementing the ICD-10-CM diagnostic coding system in the United States seems to be a moving target, it's never too soon to prepare for the switch. The April 1 Protecting Access to Medicare Act of 2014, which postponed a drastic 24 percent Medicare rate cut, also included a single sentence that delayed implementation of the ICD-10-CM code to Oct. 1, 2015.
The International Statistical Classification of Diseases (ICD), now in its 10th revision, is the medical classification and research standard for physical and mental disorders throughout most of the world. ICD is produced by the World Health Organization (WHO), a global health agency of the United Nations, and covers all health conditions. By comparison, the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) provides diagnostic criteria for mental disorders and is produced by the American Psychiatric Association.
Though most of the 194 WHO member countries have been using ICD-10 since 1994, at this time, ICD-9-CM remains the Health Insurance Portability and Accountability Act (HIPAA) compliant code set for billing purposes in the United States. Psychologists should continue to use the ICD-9-CM code set for coding purposes related to billing until Oct. 1, 2015.
Psychologists can use the criteria as outlined in the DSM-5 to arrive at diagnostic conclusions and then use the appropriate ICD code set for billing purposes. Most psychologists have been trained using the DSM to aid diagnostic decision-making. But many practitioners also consult other sources of diagnostic information, such as guidelines and international documents. Psychologists need to have a rationale for how they determined a diagnosis and will want their rationale to be supported by the professional literature.
When the switch to ICD-10-CM happens, psychologists will have approximately the same number of mental health codes as they did under ICD-9-CM. Although the ICD-10-CM expands the code list from 14,025 codes to 68,069, psychologists primarily use one chapter of the ICD that did not expand in number of codes. Current ICD-9-CM codes are entirely numeric, whereas the ICD-10-CM codes are alphanumeric, and mental health codes begin with the letter F.
For example, the first three characters for "phobic anxiety disorders" are F40. F is the chapter on mental and behavioral disorders, and F40 through F48 are anxiety, dissociative, stress-related and somatoform disorders. Each character afterward adds to the specificity of the diagnosis: F40.0 is agoraphobia, and F40.01 is agoraphobia with panic disorder. The ICD-10-CM code set is free and downloadable from the Centers for Disease Control and Prevention website.
Though the United States is just now preparing for the switch to ICD-10, an 11th revision is in progress. As a discipline, psychology has been more involved in the planning and processes for ICD-11's mental and behavioral disorders chapter than with any previous revision.
APA President Nadine J. Kaslow, PhD, heads an international group of psychologists, psychiatrists and other mental health professionals working to ensure that the ICD-11 devotes more attention to interpersonal factors that may affect both mental and physical health. In addition, psychologists have contributed to the research basis for the revision, and psychologists are well represented in the Field Studies Coordinating Group that guides the development and contributes to testing clinical utility of codes. ICD-11 promises even greater clinical accuracy, ease of use and appropriate fit in clinical diagnoses. Much like ICD-10 adoption in the United States, the expected date for completion of ICD-11 is a moving target: WHO now anticipates the final version by 2017.
For psychologists who are looking for guidance on the ICD, APA offers "A Primer for ICD-10-CM Users: Psychological and Behavioral Conditions," by former APA President Carol Goodheart, EdD. More information about the ICD-10 can be found on the APA Practice Organization's Practice Central website.
