Much has been written about the pros and cons of the ICD-10 delay. To date, CMS has yet to issue the new deadline, or provide guidelines for how organizations are to proceed. While CMS is pondering the legal ramifications of applicable laws, and we wait for decisions, I have noticed some relief of the delay for one specific reason: the noted contextual differences between the ICD-10/DSM-5 and trying to explain these differences to clinical staff.
Since we must use both the DSM-5 and the ICD-10, we are subsequently bound by the two code sets. Therefore, we must become educated not only in the diagnostic criteria of both code sets, but the numerical and other differences between them. At first glance, the two code sets appear similar, but upon closer reflection, they are not. As a matter of fact, there are significant discrepancies between the two codes sets and it will be our responsibility to know the differences.
I have developed a highly specialized curriculum related to the diagnostic criteria, clinical documentation standards, and coding differences between the two code sets. The development of this curriculum has been a tedious task, sometimes wondering why the ICD-10 contains certain diagnoses and the DSM-5 does not (and visa versa). There are other differences between the code sets, both distinct and subtle as well. However, it has also been absolutely fascinating to see two very different (but mandated) manuals try to explain the same medical condition. But this will present a problem for provider organizations: how will they reconcile the differences?
Our new clinical world contains new information, conceptualizations, formatting, coding and documentation requirements that can easily overwhelm medical and clinical staff. We already know the Evaluation and Management (E & M) code changes from 2013 were challenging with regards to documentation. Therefore, making sense of two disparate manuals and code sets will take detailed effort and consideration. The design of your ICD-10 clinical training program will require both a coding and clinical knowledge base. Take the extra time granted by the ICD-10 delay to really understand our new ICD-10 and DSM-5 systems and how this will affect your organization.