By: Lourie W. Reichemberg
Most of the world already uses ICD-10 to classify diseases and other health problems, to code health records and death certificates, and to capture national morbidity and mortality statistics. The ICD-10 has been translated into 43 languages and is used by 117 countries.
Within the United
States, the ICD-9-CM
(Clinical
Modification) is the current version officially used for coding and billing
purposes. This is a modified version of WHO’s ICD codes created by the U.S. National
Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid
Services (CMS). The CM versions provide additional detail and are used
specifically for medical coding and reporting in the United States (American Psychological
Association, 2012).
On October 1, 2014,
all U.S. healthcare providers covered under the Healthcare Insurance
Portability and Accountability Act (HIPAA) must begin to use the ICD-10-CM diagnosis codes. The ICD provides the code
numbers but limited diagnostic information. On the other hand, DSM-5 provides more
specific and detailed diagnostic criteria and cross-cutting measures to help
the clinician make that diagnostic determination. The complete listing of ICD codes is available
for use free of charge from the WHO website: www.who.int/classifications/icd/en
A Brief History of the ICD
The ICD has been the standard diagnostic tool for more than 150 years. It is used to monitor the incidence and prevalence of diseases and other health problems worldwide. This includes epidemiology, health management, clinical purposes, and analysis of the general health situation of population groups.
The ICD system began
in the 1850s with the publication of the International List of Causes of Death by the International
Statistical Institute. This list, which reported causes of morbidity and
mortality, was taken over by the World Health Organization (WHO) in 1948, when
the sixth revision was published.
In 1977, the ICD-9 codes were published
and are still being used, although the ICD-10 codes were approved
in 1990 and came into use in 1994 (WHO, 2010). Most countries are already using
the ICD-10
coding
system; only a few (e.g., the United States, Italy) have yet to switch over.
The U.S. Department of Health and Human Services has mandated October 1, 2014
as the deadline for switching over to the ICD-10-CM for diagnostic code
reporting across all of health care, and the implementation of ICD-10-PCS (Procedural Coding System)
for inpatient procedural reporting for hospitals and payers.
Overall, the number
of codes will increase from 17,000 codes currently in ICD-9 to more than 141,000
codes for different medical diagnoses and procedures with the implementation of
ICD-10.
Although the primary
purpose of the ICD
is
to code and record causes of mortality and morbidity (disease or illness), for
the most part, those who are responsible for mental health diagnosis and coding
will be interested in only a small section of the four-volume series put out by
WHO: The
ICD-10 Classification of Mental and Behavioural Disorders.
A Few Facts to Keep in Mind About ICD Codes
Every edition of the DSM has supplied ICD codes. All of the DSM-IV code numbers are ICD-9 codes. So if you look up PTSD in DSM-IV, it will have the same code number as DSM-5. ICD-10-CM is not just an update to the ICD-9-CM codes. ICD-10-CM follows a new alphanumeric coding scheme, and therefore the codes cannot be converted. The ICD-10 reminds us that no classification system is ever perfect, that this and other documents used for diagnosis are always evolving, and that diagnosis requires judgment and clinical experience. Readers may want to check errata sheets for ICD-10 and code revisions for DSM-5 at www.DSM5.org. Corrections through October 1, 2013, have been made to this text, so readers should be aware that, in some cases, codes in this book differ from those published in the DSM-5.CONCLUSION
It is beyond the scope of this introduction to include a complete assessment of the evolution of the Diagnostic and Statistical Manual of Mental Disorders. Interested readers will find such history in the introductory pages of DSM-5.
The takeaway message
clinicians need to know to conduct a diagnosis using the DSM-5 classification system
is the same guidance they have used in the past: A comprehensive clinical
assessment must include a complete biopsychosocial assessment of factors that
have contributed to, and that continue to sustain, the mental disorder. The underlying goal is to conduct an accurate diagnosis so that the appropriate evidence-based treatment can begin.
References
Lourie W.
Reichemberg, DSM-5™ Essentials The Savvy Clinician’s Guide to the Changes in
Criteria, 2014 by John Wiley & Sons, Inc
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