Convention Q&A: Presenter Explains the Challenges of ICD-10 and DSM-5

The 2014 AHIMA Annual Convention and Exhibit session, “ICD-10 and DSM-5: Understanding the Health and Human Service Industry’s Need for Two Codes Sets after Implementation” on Monday, September 29 at 1 p.m. will focus on behavioral health and substance abuse coding. Presenter Lisette Wright, MA, of Behavioral Health Solutions, PA, in Minneapolis, MN, will give convention attendees guidelines on how to prepare for the many upcoming changes. Wright took some time to discuss the presentation with Journal staff.

Lisette Wright, MA

Lisette Wright, MA

What are you hoping members will take away from your session?

This session will help coders and others in the HIM industry understand that the field of behavioral health and substance use is being challenged in a very unique way during our ICD-10 transition. Specifically, those in the mental health industry in the US have been almost exclusively trained on a code set called the “DSM” (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association, not the ICD. The DSM and ICD codes have historically aligned, until now. Most clinicians in the mental health industry are not aware that the “DSM codes” they have been submitting on HCFA claim forms have actually been ICD codes.

Mental health clinicians must continue to use the DSM for a variety of mandated purposes, and at the same time utilize ICD-10 codes for reimbursement and compliance. The two code sets (ICD-10 and DSM-5) are not aligned, and there are over 300 differences between the codes and the clinical diagnostic guidelines for each code set. Therefore, transitioning to a new code set that differs dramatically from the newest version of the DSM (DSM-5) and remains HIPAA- and CMS-compliant will be very challenging. In fact, most in the industry are either unaware or in denial that this is the situation. Making sure leadership and clinicians know about this and that they get trained will be the hardest part of this process.

Mental health documentation standards and enforcement have historically been poor for a variety of reasons. This will all change with the ICD-10 code set, much like we saw with the 2013 E&M and CPT code changes (there were only 30 code changes then). The take-away from the session will be an understanding of the dilemma, along with practical and concrete action items that HIM professionals can take to help ease the transition at their organization.


Can you tell me more about the link between ICD-10 and behavior health?

ICD-10 contains all the diagnostic codes that mental health clinicians will need to know once the ICD-10 transition takes place. There are dramatic differences between the ICD-10 code set and the DSM, despite reassurances that all you need to know about the new ICD-10 codes are contained in the DSM-5. HIM professionals will be in an awkward position if they do not have the knowledge to help educate their clinical personnel. To say to a mental health clinician: ‘this DSM code and corresponding clinical diagnostic criteria are not sufficient or accurate for a claim’ is akin to heresy. While HIM professionals have known about the Clinical Coding and Documentations Guidelines and rules endorsed by CMS, those in the mental health industry have historically been unaware of the existence of these rules.


How can attendees start incorporating the lessons from your session right away?

Wright: Changing an entrenched organizational culture (i.e., DSM) requires executive leadership. Have your HIM leadership work with others to educate both the mental health clinicians and the staff at your organization. To date, only one such training and curriculum exists in the country that accomplishes this task. Most standard “ICD-10 trainings” or “DSM-5 trainings” are inadequate.


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