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ICD-10 and DSM-5: History, education and culture

September 21, 2014
by Lisette Wright
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As I continue to make my way around the country sharing the “ICD-10 and DSM-5 Coding, Documentation, and Clinical Diagnostic Criteria Training,©" I learn how others have come into awareness of the ICD-series itself. Some people learn about it from reading or a workshop they attended. Two people say they learned about it in graduate school (Ohio, N.Y.). Most have heard of it via their EHR vendor who will “take care of it for us.” One participant learned from her State Medicaid agency.

I then ask about the content differences between what they have learned from others versus my curriculum. Suffice to say, even some DHS content does not impart a thorough training.

Bottom line: provider organizations are at great risk moving forward with auditors, RAC and PIG audits. There will be NO wiggle room moving forward. Even the major accrediting bodies have now jumped on-board with their guidance on integrated health. That means providers must know how to incorporate ICD-10 medical issues into the client record.

There is no relief in sight: at an upcoming federal government meeting on ICD-10 codes this month for possible adjustments, there is not a single mention of any mental health/substance use codes on the two-day long agenda. What does this mean for you? You must know a whole bunch of things that you were never taught before (or taught incorrectly), and to a level of detail that will spin your mind if you want to hang on to revenue. Specific examples of what I am talking about:

  • “Other Specified” is explicity defined in ICD-10. Anyone still using “Other Specified” after about the third or fourth session runs a risk. Run a report of the top 10 diagnoses in your organization. The results will tell the story.
  • For the encounter, you must code for every diagnosis addressed in the encounter. That is why there are increased numbers of boxes in the Diagnostic section on the new claim form. Suicide attempt? There is a code for that.
  • Look at the new diagnostic criteria and determine how diagnoses must change because they do not meet ICD-10 diagnostic criteria. A simple example is “PTSD.” PTSD is now: Unspecified, Acute, Chronic. Do you know the differences, the guidelines about criteria, when and how to use the diagnoses?

But the real problem is in convincing our graduate programs in the United States to shift away from focusing so heavily on the DSM and to begin to teach clinicians what they needs to know: the ICD-series, accompanying regulatory applications, and how the DSM-ICD complement each other. 

Continuing education attempts are laudable, but not enough. It must start with our new generation of practitioners as they start to form their diagnostic and clinical documentation habits during internships. I cannot recall a time in the industry’s history when a new piece of information so heavily impacted the education of our early career practitioners as right now with ICD-10. Graduate schools and academia must step up to the call if we are to remain fiscally solvent. Dr. Moffic's  blog entry, "Guess Who Has Newfound Support for Coding?" summed it up best: it will be a "daunting task" over the next year.


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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