Diagnostic codes can sometimes seem a little arcane, even to those therapists and physicians who are experienced with using them. Two of the more scrutinized diagnostic codes come into play when choosing to use the ICD-10 or the DSM-5 code. In truth, there are some differences and similarities between the two sets, which can make it confusing to know which one to use.
In some cases, applying the wrong diagnostic code can draw questions and cause delays in the process of submitting a claim. This can then snowball into intermittent delays in your practice’s revenue stream. To solo practitioners and administrative staff know which code is appropriate at which time, we are going to have to take a closer look at the two codes, and some of the situations to use them.
What Is DSM-5 Code?
The DSM-5 is a common and important code used by psychologists, social workers, behavioral therapists, and other mental health professionals. It is essentially a manual for assessing diagnosing mental health disorders. It’s important to note that DSM-5 does not include information or treatment guidelines for a specific disorder. Rather DSM-5 focuses on helping the provider determine an accurate diagnosis and disorder classification.
The American Psychiatric Association initially published the “Diagnostic and Statistical Manual of Mental Disorders” in 1952. The underlying goal was primarily to create a standardized nomenclature for psychopathology. The DSM was the first standardized code of its time and helped to eliminate errors caused by the separate diagnostic systems that were in use at that time. Its effectiveness and efficiency lead to the APA recognizing the issue and certifying DSM codes as the industry standard.
At that time, DSM was only used for 60 specific disorders. Today DSM-5 has evolved to the point where it is used for over 300 mental health disorders.
The number 5 was added to the DSM title to indicate that this is the fifth updated iteration of the Diagnostic and Statistical Manual of Mental Disorders, which was published in 2013. It has not been modified updated or altered since.
The DSM manual serves to avoid diagnostic confusion in practical diagnostic work, by offering a common language for clinicians at all levels. This includes specific criteria to better facilitate an objective assessment of the symptom presented by a patient.
What Is ICD-10 Code?
ICD stands for the “International Statistical Classification of Diseases and Related Health Problems.” The number 10 is attached to it as the current iteration is the 10th revision that is recognized internationally by the World Health Organization.
ICD-10 is essentially a medical classification list that contains codes for diseases, which includes things like the signs and symptoms, as well as abnormal findings, noted patient complaints, social circumstances, and even details like the external causes of an injury or a disease.
This is a standardized international coding system use by all WHO member nations to help assist in the tracking and reporting on diseases and conditions on a global level.
The ICD codes were originally published in 1983, though they have seen vigorous updates in the decades since. ICD codes were originally supported by the World Health Assembly in 1990 and were then introduced in 1994 by World Health Organization’s 30 member nations. It’s also been adopted by roughly 120 other nations that are not technically considered WHO member nations, yet still, use the standardized ICD-10 codes to report on diagnostic and medical statistics. Not only does this robust international use help to track diseases and conditions on an international scale, but it also includes cause of death reports and other key statistics.
In the United States, the National Center for Health Statistics maintains the domestic version of ICD-10, which is a slightly modified version of the international ICD-10 codes used by the WHO. The World Health Organization endorses this iteration by noting it as ICD-10 CM for “Clinical Modification.”
At this scale, the US ICD-10 CM has over 70,000 codes and its codes are used by healthcare professionals for claims submission, reporting, and reimbursement. The update went into effect in November of 2015 and has not been updated or altered since.
For the most part, DSM-5 is used by mental health professionals for diagnostic and treatment purposes. Then ICD-10 codes are used for filing a claim to an insurance company or other payer institution for reimbursement.
Are Two Code Sets Redundant?
At first glance, DSM-5 codes might seem unnecessarily redundant, especially since mental health providers still need to use ICD-10 CM codes for filing a claim. Though the benefit is that the DSM-5 gives mental health professionals criteria a common language and a set of definitions that classify diseases, and mental health conditions with specific detail. This plays a critical role in providing their patients with the highest levels of care.
The ICD-10 CM codes are then only necessary for filing a claim and being reimbursed promptly. ICD-10 CM codes cover the whole of human physiology and are not as specific when it comes to mental health disorders outlined by the DSM-5 manual. For a submitted claim to be accepted and processed properly for prompt reimbursement, the claim must use ICD-10 CM codes.
This essentially means that mental health practitioners need to stay abreast of both DSM and ICD codes to both diagnose patients, develop effective treatment plans, and be properly reimbursed by insurance providers, public health institutions, and other payer organizations.
Indeed, DSM-5 and ICD-10 use completely separate lists and are actively maintained by separate organizations. It’s also important to note that not all diagnoses that appear in the DSM-5 code list have a direct correlation with the ICD-10 CM codes. One example of this is. dementia, which DSM-5 notes as a “Neurocognitive Disorder.”
Some Of The Most Common ICD-10 Codes For Mental Health Disorders
- F32.9 Major depressive disorder, single episode, unspecified
- F32.0 Major depressive disorder, single episode, mild
- F32.1 Major depressive disorder, single episode, mild
- F32.1 Major depressive disorder, single episode, moderate
- F32.2 Major depressive disorder, single episode, severe without psychotic features
- F32.3 Major depressive disorder, single episode, severe with psychotic features
- F32.4 Major depressive disorder, single episode, in partial remission
- F32.5 Major depressive disorder, single episode, in full remission
- F32.8 Other depressive episodes
- F33.1 Major depressive disorder, recurrent, moderate
- F33.2 Major depressive disorder, recurrent severe without psychotic features
- F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
- F39 Unspecified mood [affective] disorder
- F25.9 Schizoaffective disorder, unspecified