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Your ‘Top 10’ ICD-10 codes

August 31, 2015
by Julie Miller, Editor in Chief
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The official countdown clock at the Centers for Medicare and Medicaid Services (CMS) is keeping  time down to the very last second leading up to the ICD-10 deadline. On October 1, healthcare providers must throw out the old version 9 codes and begin using the new version 10 codes or they risk not getting paid. At least CMS is trying to be helpful in shepherding us all through the process.

For example, there are several free online tools to help even the smallest practices gear up. My favorite recommendation is the exercise of making a list of your top 10 most-used codes—whatever they might be at your facility—and referencing them in the ICD-10 dataset. You might find there are actually more than 10 codes you’ll need at your fingertips.

Here is our handy list--feel free to share it with your colleagues!

Behavioral Healthcare's Top 10 ICD-10 Codes


Source: Medivance Billing Service



These top ICD-10 codes are handy to have.

It may also be worth noting that Behavioral health providers are better served by referring to the DSM-5 to obtain diagnostic billing codes rather than by referring to either the ICD-10 tabular listings or to ICD-9-to-ICD-10 conversion tools available online.

This is because use of the DSM-5 addresses three issues associated with use of a standard ICD-9 to ICD-10 crosswalk:
* From one to many – ICD-9 to ICD-10 change has numerous instances of moving from one code to many codes, not all of which appear in the DSM-5

* Naming conventions – The name of the condition listed in the DSM-5 does not necessarily match the name of the condition as it appears in the ICD-10

* Diagnostic Criteria – The DSM-5 includes extensive criteria for the purpose of diagnosis; the ICD-10 does not

For behavioral health, the DSM-5 provides current industry-standard diagnostic criteria and descriptors, and maps to both the ICD-9-CM and ICD-10-CM code sets.

The BH/SU world continues to be confused about how ICD-10 applies to them. 2 myths I perpetually hear are: "we don't need the ICD, we have the DSM". The other is that "someone else will take care of it." With Healthcare Reform, CMS mandates, and HIPAA, we can no longer be the stepchild in healthcare. As such, we will and should be held to a higher standard than ever before. And the Payers will be looking for this.

No crosswalk is perfect, not even the CMS GEMS. Your best bet to survive this? Learn the I-10 Tabular index, document to support the diagnoses, learn the Coding and Documentation Rules and do not rely on other people (or Associations) to "crosswalk" codes for you. This stuff is hard and there is no way around it--after training close to 11K clinicians nationwide on this, they will likely agree there are no short-cuts. Payers will be flagging over utilization of Unspecified diagnoses. Don't think they won't audit you for I-10 compliance. While the DSM-5 is a fantastic re-write in many respects, so many DSM codes crosswalk to "unspecified" diagnoses whereas the I-10 Tabular has the specific codes now required. Using anything except the free, CDC/NCHS Tabular Index will put you, your organization, and clients, at risk.

Don't believe me? Look up the code for PTSD in the DSM-5 and compare it to the I-10 Tabular Index. Bottom line: really know what code you are assigning to your client. You may be surprised to see it is not what you intended it to be, or wonder why it was kicked out for further review, delaying your reimbursement.

Finally, the Tabular Index gives us GREAT new codes to use that are critical to our patient care: all the Intentional Self-Harm codes (X-codes) are vital to code for, document, and diagnose. Clinicians will come to really like the cool options in the free, ICD-10 CM Tabular Index (hint: especially those who work with kids!).

Julie Miller

Editor in Chief

Julie Miller


Julie Miller has more than 14 years of experience observing, analyzing and reporting on various...

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