May 1st, 2013

ICD-10 code change deadline pushed back

While some psychologists are still dealing with the aftermath of changes to CPT codes in January, another, and much broader, code change deadline has been pushed back a year.

Last summer, the US Department of Health and Human Services announced a one-year delay in a compliance deadline for the conversion to new diagnostic code sets known as ICD-10. While the announcement has largely gone under the radar for the psychological community, it is one that should be taken note of because it will affect the way diagnostic codes are reported to health insurance companies.

The ICD-10, or tenth edition of the International Classification of Diseases, is a diagnostic coding system created by the World Health Organization. The codes are released in the U.S. as ICD-10-CM for use in all health care settings or ICD-10-PCS for use in inpatient hospital settings. This latest version was issued in 1993 and is used by nearly all of the 193 WHO member countries…with one major exception: the United States.

“The U.S. did not convert at that time,” says Lynn Bufka, Ph.D., assistant executive director for research and policy for the American Psychological Association (APA), “and part of the reason was that we are so large and our health care system is fragmented in so many ways so part of the dilemma had to do with making it work for everyone.”

The U.S. will finally come into line with the coding system on Oct. 1, 2014. The 11th edition, now in process of being finalized, will be brought online more gradually, by way of yearly updates. All health care providers and other entities, covered by the Health Insurance Portability and Accountability Act (HIPAA) will be required to convert to the updated codes.

What some practitioners don’t realize is that they are already mandated to use the ICD-9 codes. Since the American Psychiatric Association’s DSM (Diagnostic and Statistical Manual of Mental Disorders) codes are virtually similar to the ICD-9 codes, the system recognizes them even if the practitioner is using the DSM to ascribe diagnostic codes.

“I was not aware that our DSM-IV codes were currently matching up with the international code system,” says Juliette Bermingham, Psy.D., a licensed psychologist with Salem Psychological Associates in Salem, N.H. “I do know there has been a lot of excitement over the new DSM-5 coming out.”

So, if the codes have been pretty much the same and the awareness level so low, why worry about the pending changes? The answer is that the new codes will most likely no longer be in harmony with the DSM. Unless changes have been made to DSM-5 from the online examples, the codes will not match up with ICD-10. The ICD-10 codes were changed from numeric to alpha-numeric in order to increase the number of classifications. There will also be far more codes. The ICD-10-CM will contain approximately 68,000 codes, up from ICD-9’s 4,000.

In the meantime, when the DSM-5 is released this spring, any code changes in that would most likely not be in line with the current ICD-9 and should not be used, says Bufka.

“In terms of billing purposes,” she says, “continue the same codes you are using now from the DSM-IV-TR. If a person switches to DSM-5 codes, they will not be accurate.”

To help psychologists and psychological practices come into line with the changes, the American Psychological Association plans to have a CE course and convention programming around the subject. State organizations will also have workshops and additional information as the date gets closer.

“I think that psychologists should start familiarizing themselves with the ICD-10 now,” says Elena Eisman, Ed.D., executive director of the Massachusetts Psychological Association. “The manual is free online and there is open access. Plus, there will be information published by the psychological associations in the near future targeted to helping psychologists moving to ICD.”

Since the HHS gave everyone an additional year to come into compliance, the Oct. 2014 date will be an absolute deadline and anyone not using the new codes for services occurring on or after that date could face fines. The process should go more smoothly than the change with the new CPT codes in January if only because there is far more time for all affected parties to make the changes.

“I really don’t expect any problems,” says Eisman.

By Catherine Robertson Souter

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