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ICD-10 and DSM-5 Part 2: Language and Coding

July 28, 2014
by Lisette Wright
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This article will update you on my last posting, “ICD-10 and DSM-5: The Language and Coding Conundrums.” I received fantastic comments from my colleagues in the industry who have been just as involved with the ICD/DSM issue. They provided me with some helpful information and conceptualizations. After reviewing the information, my takeaway remains the same: The provider is left with a confusing and at times contradictory system of diagnosing and coding (DSM versus ICD) where hopes for resolution are not in the near future.

First, here is the concrete information. I have summarized it into an easy-to-understand format:

  1. The American Psychiatric Association (APA) is requesting (limited) reconciliation between some codes in the DSM manual with the ICD-10 CM as a part of the ICD-10 CM revision process in the United States. However, only a small subset of the noted discrepancies were introduced for consideration in 2013.
  2. The Protecting Access to Medicare Act (PAMA) of 2014 delayed the implementation of ICD-10 CM in the United States, with an interim rule subsequently issued stating the go-live of ICD-10 CM codes is now October 1, 2015.
  3. The U.S. ICD-10 CM authorities issued a partial code freeze on changing any ICD-10 CM codes in the U.S. until one year post-implementation of ICD-10 CM. This was done in order for all stakeholders to adequately prepare their systems for the ICD-10 CM go-live.
  4. Unless something changes, the first date that new, approved codes can be incorporated into the ICD-10 CM is October 1, 2016.

In the meantime, meetings at the national level continue and APA continues to work the issue. As you can imagine, this process will take a long time and may never be achieved in totality given the number of discrepancies. Even if some changes are made, they will not likely be made readily evident to the public. This leaves the practitioner essentially where we started.

Part of the rationale for the development of the DSM was to help create a common terminology and diagnostic criteria for mental disorders. Yet, we are now left with two manuals and even more confusing layers of payer rules. For example, one very large private insurer in the U.S. has indicated they will implement DSM-5 on October 1, 2014 and concurrently retain the use of the GAF score (the GAF was removed from the DSM-5).

Telling mental health clinicians that there are no such things as DSM codes is akin to heresy. One reader offered this helpful way of conceptualizing the matter: “There are no such things as DSM codes, in either DSM-IV or DSM-5. All codes in all DSM editions have been, and always will be, ICD codes.”

One of the objectives in health IT is to standardize for better healthcare outcomes and to meet the Triple Aim. Given our industry’s dilemma, this seems illusive. One reader said it best:  “The DSM may be thought of one resource for a descriptive guide to diagnosing but should not be relied upon for coding and documenting in the medical record.”

Bottom line for you as a provider? You will need to take a whole new approach to coding and documenting. In other words, know the ICD-10 CM and the corresponding coding rules.


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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