ICD-10 Transition Helpful Tips

As we all know, we are changing to ICD-10 for billing. Below are some reminders, links and facts to help with the transition.

1. Use ICD-10 diagnostic codes for Dates of Service (DOS) October 1st and later.

  • Be sure to use ICD-9 codes for all DOS in September and ICD-10 codes for all DOS in October and later – no matter when you submit the claim. If you submit a claim on 10/5 for a session on 9/28, use the ICD-9 diagnostic code.
  • Do not submit a bill on one CMS-1500 form that includes both DOS prior to 10/1 and DOS 10/1 or later.
  • Use ICD-10 codes on requests for prior auths for DOS 10/1/15 and later.  You do NOT need to submit a new auth request simply to change to the ICD-10 diagnosis if your current auth spans the 10/1 date.
  • When submitting on the CMS-1500 paper claim form, do NOT use the period in the diagnosis.
    With online billing, continue to do what you have been doing for each particular insurance company.

2. When submitting ICD-10 codes on the CMS-1500 paper claim form, be sure to change the “9” to “0” on line 21, “ICD Ind.”

3. This change to ICD-10 and DSM-5 will have no effect on the CPT codes, keep using the same CPT codes (90836, 90791, 90847 etc).

4. The DSM-5 manual is very helpful. It lists all the ICD-10 codes (in parentheses, in gray) right next to the descriptive DSM diagnoses. If you have not yet purchased it, you can order by phone, 800.368.5777 or online, www.appi.org/Home.  It is also available at http://www.valore.com/about-us/valorebooks/

DSM-5 has several crosswalks from ICD-9 to ICD-10:

  • An alphabetical listing of all diagnoses with their ICD-9 (what we used to call DSM-IV) codes and ICD-10 codes; and
  • A numerical listing of all the ICD-10 codes and their DSM-5 diagnoses.
5.  Here are easy online crosswalks to use – type in the ICD-9 code (“DSM” code) you are currently using, and either site will give you the corresponding ICD-10 code:

6. Unfortunately, the available version of DSM-5 has some mistakes. There is a correction sheet on page 3 of the APA Coding Update: http://dsm.psychiatryonline.org/pb/assets/raw/dsm/pdf/DSM-5%20Coding%20Update_Final.pdf

It appears that only 3 changes apply to the codes we generally use (most of the changes pertain to neurocognitive issues). Of note, the 3 diagnoses we might use:

  • Bipolar I Disorder, hypomanic, in partial remission should be F31.71
  • Bipolar I Disorder, hypomanic, in full remission should be F31.72
  • Adjustment disorders should now be specified as ACUTE (less than 6 months) or PERSISTENT/CHRONIC (6 months or longer).  This is a significant change from DSM-IV.
  • Put all specifiers  – for any diagnosis – in your chart, but not on the claim form.
    There is no ICD-10 code that differentiates acute from persistent adjustment disorder.

7. There may be reimbursement delays during the early months of implementation of ICD-10. Billing services, clearing houses and the insurance companies themselves may have a rocky start.  We hope not.

8. Other than that, don’t stress. Most of the brouhaha over ICD-10 appears to be because the medical (not the psychiatric) diagnoses have mushroomed, and now necessitate a much greater degree of specificity. ICD-9 had approximately 13,000 codes; ICD-10 has approximately 68,000 codes.  But the number of codes in mental health, about 700, has barely increased.

9.  Once we learn to how to translate the codes for the diagnoses we tend to bill – and there are plenty of very easy crosswalks to use – billing will be simple. The DSM part, what we note in our charts, is a little more complicated, but as we use it, we will become conversant with it.

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