International Statistical Classifications of Diseases (ICD-10)

Frequently Asked Questions

• Background
• General DSM-5

Background

1. What is the Diagnostic and Statistical Manual of Mental Disorders (DSM)?
   The Diagnostic and Statistical Manual of Mental Disorders (DSM) contains descriptions, symptoms, and other criteria for diagnosing mental disorders. Until May 2013, the DSM-IV-TR was the most recent version of the manual. The DSM is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children.

2. What is the International Statistical Classifications of Diseases (ICD)?
   The International Statistical Classifications of Diseases (ICD) codes are alphanumeric descriptions given to every diagnosis and description of symptoms (ICD 9 codes are numeric, except for those for certain medications like analgesics - ICD 10 becomes alphanumeric). These classifications are developed, monitored and copyrighted by the World Health Organization (WHO). Each diagnosis has a numbered description and code that is associated with it. The global descriptions and coding allow all medical providers in the United States and many other parts of the world to understand the diagnosis the same way.

3. Why are changes needed to the current ICD-9 codes?
   The ICD-9 code system is old and has difficulty reflecting advances in medical knowledge and technology. Increased specificity included in the ICD-10 codes will generate better data on procedure and diagnosis trends that should result in improved patient care. In addition, ICD-9 codes do not capture data relating to other factors affecting health – especially important for academic and government research and for public health, pandemics, and bioterrorism.

4. What is "ICD-10"?
   "ICD-10" is the abbreviation for the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10- PCS). The purpose of this publication is to provide a standardized system of reporting data.

5. How are DSM-5 and ICD related?
   ICD codes are used for claims submissions; DSM-5 includes criteria that are used to diagnose patients. You may also use DSM-5 when you request a care authorization from us.
   Per the American Psychiatric Association, DSM-5 contains both ICD-9-M codes for immediate use and ICD-10- CM codes in parentheses for future use. The ICD-10-CM codes will be implemented as recommended by the Centers for Disease Control and Prevention's National Center for Health Statistics (CDC- NCHS) and the Centers for Medicare and Medicaid Services (CMS).

General

1. When will I need to begin using DSM-5?
   We encourage health care providers to use DSM-5 when diagnosing patients and when requesting authorizations from us.

2. What are the major differences in the DSM-IV-TR and DSM-5?

   • The multiaxial system (Axes I-V) has been abandoned.
   • DSM-5 combines all diagnoses onto a single axis (previously Axes I-III).
   • Contributing psychosocial and environmental factors or other reasons for visits (previously Axis IV) are now represented through an expanded selected set of ICD-9-CM v codes and, from the forthcoming ICD-10-CM, z and t codes.
   • Axis V eliminated, clinicians are no longer required to use the Global Assessment of Functioning Scale.
   • Most of the diagnoses and relevant criteria included in DSM-5 remain identical, or similar, to those in DSM-IV-TR
   • Example of how a diagnosis could be recorded using DSM-5's single axis system:
   • Agoraphobia (300.22); congenital hypothyroidism (243); acculturation difficulty (V62.4); WHODAS2.0 = 88
   • ICD Codes accompany each criteria set, but some codes are used for multiple disorders.
   • For example, hoarding disorder and obsessive-compulsive disorder share the same codes (ICD-9-CM 300.3 and ICD-10-CM F42).
   • Because of this, the DSM-5 diagnosis should be always be recorded by name in the medical record in addition to listing the code.
   • Mental retardation in DSM-IV is referred to as Intellectual Disability Disorder in DSM-5. Diagnostic criteria for intellectual disability (intellectual developmental disorder) emphasize the need for an assessment of both cognitive capacity (IQ) and adaptive functioning. Severity is determined by adaptive functioning rather than IQ score.
   • Substance Use Disorders: Coding will be applied based on severity:
   • ICD codes associated with substance abuse will be used to indicated mild Substance Use Disorders
   • ICD codes associated with substance dependence will be used to indicate moderate or severe Substance Use Disorders
   • Throughout DSM-5, Not otherwise Specified [NOS] is replaced with two options:
   • Other - used in situations in which a clinician chooses to communicate the specific reason that the presentation meets some but not all the criteria for a specific disorder
   • Unspecified - used in situations in which a clinician chooses NOT to communicate the specific reason that the presentation meets some but not all the criteria for a specific disorder and includes presentations in which there is insufficient information to make a more specific diagnosis.
   • Autism Spectrum Disorder (ASD) is a DSM-5 name that reflects a scientific consensus that four previously separate disorders are actually a single condition with different levels of symptom severity in two core domains. ASD encompasses the previous DSM-IV-TR autistic disorder (autism), Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified.
   • The DSM-IV diagnoses of dementia and amnestic disorder are listed under the entity Major Neurocognitive Disorder.
   • The criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV-TR.

3. Where can I go to find out more about these changes?
   The American Psychiatric Association (APA) and the DSM-5 website are both resources.