ICD-10 implementation delayed until October 2015

Here's the practical upshot and related guidance for practitioners.

The Protecting Access to Medicare Act of 2014 did more than avert the 24 percent Sustainable Growth Rate (SGR) cut to Medicare provider payments scheduled to take effect on April 1. It also contained a provision that delays implementation of the ICD-10-CM code set until Oct. 1, 2015. Before the April 1 law was enacted, ICD-10-CM implementation had been scheduled for Oct. 1, 2014.

So what does this mean for practitioners? Psychologists should continue to use the ICD-9-CM code set for coding purposes related to billing. ICD-9-CM remains the Health Insurance Portability and Accountability Act-compliant code set for billing purposes in the United States until the new October 2015 implementation date for ICD-10-CM.

When psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) publications from the American Psychiatric Association for diagnostic purposes, they are actually seeing ICD codes. The codes listed in DSM-IV-TR are the ICD-9 codes for corresponding disorders.

The DSM-5 lists both ICD-9-CM and ICD-10-CM codes alongside the diagnostic names, and includes extensive diagnostic criteria. The ICD-9-CM codes are entirely numeric, whereas the ICD-10-CM codes are alphanumeric and the mental health codes begin with the letter F.

Psychologists who review or use the DSM-5 can find the codes in the introductory classification section, with ICD-10-CM codes in parentheses next to the ICD-9-CM codes as well as alphabetical listings of both ICD-9-CM codes and ICD-10-CM codes in the back of the manual. Those who do not use the DSM-5 can find the ICD codes on the CDC website.

The American Psychiatric Association recommends that DSM users switch to DSM-5 if they have not yet done so already. Psychologists can use the criteria as outlined in the DSM-5 to arrive at diagnostic conclusions and then use the appropriate ICD code set for billing purposes.

However, rather than using the DSM-5, psychologists could also consult other sources of diagnostic information such as guidelines and international documents to arrive at their diagnostic decisions. Psychologists need to have a rationale for how they determined a diagnosis and will want their rationale to be supported by the professional literature.

Although the DSM-5 is often used for mental health diagnostic criteria in this country, it is important for psychologists to use the ICD codes for billing and coding purposes. The ICD does not provide the level of detail that the DSM-5 provides regarding diagnostic criteria. Even so, ICD does provide diagnostic categories, names and codes.

More information about the ICD-10 can be found on the APA Practice Organization's Practice Central website.