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ICD-10 and DSM-5: Awakenings

January 31, 2015
by Lisette Wright
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Some progress in the US towards "getting it"

Coming into gradual awareness of a situation, and the true implications of the ICD-10/DSM-5 situation for provider organizations is a process that has to originate from within. To be told that ICD-10 and DSM-5 are coming and they will deeply affect both your clinical and operational processes does not mean provider organizations will “get it.” On the contrary, throughout the country, I still see signs of precarious “readiness” states:

  • Denial that ICD-10 even applies to BH/SU organizations
  • Myths that the new DSM-5 contains everything you need to know about ICD-10
  • “I didn’t realize the DSM was not HIPAA compliant!”
  • That there IS a difference between DSM-5 and ICD-10
  • “The need for our agency to actually use ICD-10 was new information” (to the reviewer)
  • ICD-10 will be postponed again

On the flip side is the uptick in awareness that indeed, BH/SU organizations are way behind in preparedness and the “urgent” need to get clinical and organizational training ASAP. So many initiatives are hitting providers hard these days: Meaningful Use and PQRS penalties, mandated EHR systems, SNOMED codes, Value-Based Purchasing programs (yes, this affects you), integrated care models and mandates, bundling/unbundling of child welfare payment models, and more. In addition, there are counties or states that are not even on the DSM-5 yet, or who just starting to mandate the use of CPT codes. Then there are the regional governing entities that are falling apart under a tsunami of change.

The volume of change is both overwhelming and at the same time, past-due. It is absolutely necessary to sustain best practices, accountability, evidence-based care, and bring our industry in line with higher standards and thresholds. This is not a feel-good position,or "nice-to'have:" it is mandated by CMS (Center for Medicare/Medicaid Services) and it is what the payers will expect. Most importantly, it is what consumers expect and demand regarding transparency (eg: the OpenNotes Initiative).

It is not sufficient to learn the DSM-5 or the ICD-10 in isolation. They must be taught collaboratively, with the contextual understanding of how they relate to eachother. Policies and procedures must be devised, billing rules in your EHR must be assessed, and a new way of documenting must take place to be in compliance. Even for those very large, multiple provider organizations who have made the trending decision to “not use the DSM and just go with ICD” they must understand what is happening, why, and how to proceed. When then, will the graduate schools start teaching what clinicians need to know in the real world (ICD)? As a result, the burden of training the staff is on the provider organizations. Are you ready to do this?

Until this happens, the awakening in provider organizations has not really happened. While providers themselves are not fond of this message, the QA departments and a few of you do, finding available and truly competent training resources at this stage in the game will be difficult.


Lisette Wright

IT Consulting for Health and Human Services

Lisette Wright


Lisette Wright, M.A., LP has over 20 years of experience in the healthcare...

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