All Diagnosis Codes Changed October 1, 2015 to ICD-10 Codes

By Barbara Griswold, LMFT 

The DSM-5 came out in 2013, and some of us are still getting used to changes in some of our most frequently-used diagnoses. Well hang on, and spread the word: ALL diagnosis codes are changing on October 1, 2015.  This affects ALL therapists, both network providers and out-of-network providers.

First, a little context: Think of DSM codes as the psychiatric section of an extensive list of all medical diagnoses called the International Classification of Diseases (ICD). So if you are asked for an ICD diagnosis, don’t worry – you can use a DSM code and it will be the same.

Right now the DSM codes we are using are from the ICD-Ninth Edition, or ICD-9. But these codes are changing to a new code set, the ICD-10.  This means for all session dates October 1, 2015 and after, you must transition to the ICD-10 diagnosis code numbers for the same diagnoses we’ve been using.  To clarify:  If you've been using the DSM-5, the diagnoses themselves aren't changing, just the codes. 

But here’s some good news: For each diagnosis in the DSM-5 you will see listed both the ICD-9 codes in black and bold (for use prior to October 1st), as well as the ICD-10 codes (in gray and parentheses, starting with a letter) for use starting October 1st.

But warning: Looking only at category headings may lead to claim denials.  For example, if you look up "Post Traumatic Stress Disorder," you will see the current code 309.81, followed by an ICD-10 code F43.10.  However, this is the ICD-10 code for "Post-Traumatic Stress Disorder, Unspecified."  You should avoid "Unspecified" diagnoses, as plans may not reimburse for them.  Also, while it may seem from looking at the heading that PTSD has only one code, there are sub-codes within this and many other diagnosis categories.  Examine the criteria for each subcode to find the best diagnosis for your case.  Tip: Page 839 of the DSM-5 has a helpful and easy to use Alphabetical Listing of diagnoses, with both the ICD-9 and ICD-10 codes for each.

One other important caution:  Many plans won't pay if you only list a "phase of life issue" (what was a V-code in the ICD-9, now a Z-code in the ICD-10). 

Coding on the CMS-1500 claim:  Put the new diagnoses in Box 21.  Don't include parentheses or write the diagnosis name on the claim. However, in the upper right-hand corner of Box 21 where it asks for ICD-In (ICD Indicator), for sessions starting October 1st you should put a “0” (not a “10”) where you currently put a 9 — just before the vertical dashed line -- to indicate you are using the ICD-10. 

Q: “What if I submit claims after October 1st for sessions prior to October 1st?”  

A: Use ICD-9 codes for dates of service prior to October 1st, and ICD-10 codes for sessions October 1st and after.  Use separate claims for any pre-October dates of service and one for those October 1st and after.

Q: "I thought the Codes just changed in 2013?" 

A:  Those were the CPT Codes, which are the codes for the type of therapy provided (couple/family, diagnostic intake, psychotherapy 45 minutes, etc), not for diagnoses.

Q: "What should I do to prepare for the transition?"

A: If you use claims software, a claims clearinghouse, or a billing service, make sure it is ready for the transition.  And it may be time to shell out for your DSM-5 if you haven’t already.  You can get your copy from the American Psychiatric Association or from Amazon.com (save money by ordering the paperback). 

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Barbara Griswold, LMFT is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should, now out it its 6th edition.  She has a private practice in San Jose, California, and she invites you to contact her with your insurance questions and problems. Visit her website at www.theinsurancemaze.com to subscribe to her free monthly e-newsletter, to read helpful articles, to view her workshop schedule, or to schedule a consultation.