Diagnostic Criteria is set list of principles or standards that is used in the identification of diseases by the examination of the symptoms and signs and by other investigations.
DSM 5 (The Diagnostic and Statistical Manual of Mental Disorders) is a particular Diagnostic Criteria for diagnosing mental disorders.
DSM 5 is a Problem Descriptor - no code
ICD-10 (International Classification of Diseases) is the "international standard for defining and reporting diseases and health conditions. It allows the world to compare and share health information using a common language. It defines the universe of diseases, disorders, injuries and other related health conditions."
ICD-10 is a Problem Descriptor AND Code
When a Counselor or Therapist goes to school and learns how to diagnose their patients, they are taught to use the DSM 5 (this particular Diagnostic Criteria).
When a Counselor or Therapist goes to work and has to diagnose an actual patient, they must use the DSM 5 AND the ICD-10.
The DSM 5 is what the Counselor or Therapist uses to identify the definition of the patient's problem. They then have to map and document the ICD-10 Diagnosis Code and Description in order to send that information to the payer to get paid.
Now, you can't have one without the other. ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).
Imagine you went to school to learn to speak and write in French. You studied for a specific test on French and you passed! You learned all about how to write your documents in French and are now credentialed.
Now imagine you got a job! You now get to put your knowledge to practice and you start seeing patients. You see a patient and ask them a lot of questions and decide they have a certain diagnosis. Now you have to document all of the questions and answers so that when other people review your work, they can understand how you came to your conclusions about that diagnosis. You write it all in French. Unfortunately the people who pay you, only know German. You now have to also document the translation of the diagnosis in German. There is not always a direct one-to-one translation. You have to do your best to translate as closely as possible and defend the reasoning behind your translation.
To make matters worse, there are actually 2 types of ICD-10 Codes.
There is the ICD-10 as produced internationally by WHO (World Health Organization). The World Health Assembly adopted ICD-10 in 1990. They started the ICD-11 Beta Phase on May 14, 2012 and the final ICD-11 revision is due by 2018. This international version of ICD-10 is referred to sometimes as the Blue Book or the Green Book. Again, these are International versions of the ICD-10 codes.
Why reference the Blue Book or the Green Book at all?
The Blue Book and the Green Book include Diagnostic Criteria. They include information on underlying issues or symptoms that can be used to map them to a particular problem or Diagnosis.
The US ICD-10-CM (Clinical Modification), sometimes referred to as the "ICD-10 Tabular Index" is the list of Codes and Descriptions for diagnosis coding for use in all U.S. health care settings. There are differences between the ICD-10 and the ICD-10-CM. You may find a code in one and note the other.
Procentive has the ICD-10-CM (or ICD-10 Tabular Index) loaded into the Diagnosis Module for our customers. These are the ONLY diagnosis codes available for use in all U.S. health care settings.
So why have the DSM 5? According to the APA, "DSM-5 and the ICD should be thought of as companion publications. DSM-5 contains the most up-to-date criteria for diagnosing mental disorders, along with extensive descriptive text, providing a common language for clinicians to communicate about their patients. The ICD contains the code numbers used in DSM-5 and all of medicine, needed for insurance reimbursement and for monitoring of morbidity and mortality statistics by national and international health agencies. The APA works closely with staff from the WHO, CMS, and CDC-NCHS to ensure that the two systems are maximally compatible."
So to conclude, Counselors and Therapists should diagnosis in DSM 5 then use the Blue Book or Green Book (international versions of ICD-10) to diagnosis in ICD-10 and then double check the ICD-10-CM (ICD-10 Tabular Index) to make sure the code and diagnosis they have chosen is recognized in the US. They then need to document their findings and conclusions with the DSM 5 AND ICD-10.
Tips from CMS:
• While crosswalks from ICD-9 to ICD-10 can be useful references, ICD-10 codes should be based on the clinical documentation rather than selected from a crosswalk
• Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015
Information related to this can be found:
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