ICD change on the horizon, but not so soon

Members have contacted APA after seeing conflicting dates for ICD-10-CM implementation.

By Practice Research & Policy staff

Feb. 28, 2013—A change in the way psychologists bill for services is on the horizon, but it’s more distant than originally planned. Though new ICD-10-CM codes were initially scheduled to go into effect Oct. 1, 2013, the Department of Health and Human Services (HHS) will not require providers to use the ICD-10-CM code sets to report diagnoses until Oct. 1, 2015.

At that time, the ICD-9-CM code sets will be replaced by ICD-10-CM code sets. The transition to ICD-10-CM is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). This change in billing represents a significant shift away from how psychologists presently bill for services.

Currently, many psychologists utilize the DSM-IV-TR when diagnosing patients, and the corresponding DSM-IV-TR codes to submit a health insurance claim. Presently, those diagnostic codes mostly align with the codes in the ICD-9-CM. So providers who bill using DSM-IV-TR largely have avoided problems with claims submission based on the diagnostic classification scheme used.

However, the scenario changes once the focus shifts to ICD-10-CM.

One notable difference between the ICD-9-CM (and DSM-IV-TR) codes and the ICD-10-CM codes is that the ICD-10-CM codes use alpha-numeric characters rather than just numeric. So, unlike the case with ICD-9 and DSM-IV-TR codes, it appears that the ICD-10-CM and DSM codes will not be congruent. Anyone who bills DSM codes in lieu of ICD-10-CM codes presumably will experience claim denials.

If practitioners elect at this time to continue using the DSM-IV-TR (or the forthcoming DSM-5) for case conceptualization purposes, that is a matter of prerogative. However, ICD-9-CM codes are currently required for reporting diagnoses on health insurance claims, and ICD-10-CM codes will become the new industry standard when submitting claims to insurers beginning in October 2015.

For resources to help in this transition, clinicians are encouraged to review the educational materials distributed by the Centers for Medicare and Medicaid Services (CMS). More information about what the transition to the ICD-10-CM means for psychologists is also available on Practice Central.

The APA Practice Organization (APAPO) and APA will provide further information and resources about the new codes and the transition to the ICD-10-CM over the next 18 months.