What Psychologists Need To Know About The Coding System
ICD-10-CM Resource for PsychologistsWhat psychologists need to knowabout the coding systemSince October 1, 2015, psychologists and other health care professionals have beenrequired to use the ICD-10-CM for diagnostic coding and billing purposes. The followinginformation provides practical information on the ICD-10-CM and an easy-to-usecrosswalk of the codes.Some ICD basicsThe International Classification of Diseases (ICD)diagnosis classification system is developed by theWorld Health Organization (WHO) and used globally.ICD-10-CM is the “Clinical Modification” of the WHO’sICD-10 as adapted by the Centers for Disease Controland Prevention’s National Center for Health Statisticsfor use in the United States.ICD-10-CM is the code set that complies with theHealth Insurance Portability and Accountability Act(HIPAA) effective October 1, 2015 – the date it replacedthe ICD-9-CM code set. All entities covered underHIPAA – not just those who submit Medicare andMedicaid claims – were affected by the switch to ICD10-CM. Psychologists are covered by HIPAA if theyelectronically transmit protected health information (asdefined by HIPAA) in connection with insurance claimsor other third-party reimbursement.Health care professionals are required to record adiagnostic code (or codes) on health insurance claims.ICD-10-CM codes must be used in diagnosis codingon electronic and paper claims for services providedon or after October 1, 2015.The change to ICD-10-CM did not affect procedurecoding (Current Procedural Terminology, or CPT ) foroutpatient and office services.Why was a new version of ICD developed?WHO published the ICD-10 in 1992 and it began to beused internationally beginning in 1994. The U.S. wasslow to transition for a variety of reasons, one of whichwas that the development of the CM version takessome time. Additionally, the ICD-10-CM contains nearlyfive times as many diagnosis codes as the ICD-9-CM–more than 68,000 in total. Yet psychologists generallyuse a relatively small number of codes.APA Practice Organization apapracticecentral.orgUnlike the Diagnostic and Statistical Manual of MentalDisorders (DSM), ICD-10-CM does not providediagnostic criteria or descriptions. WHO publisheda “Clinical Descriptions and Diagnostic Guidelines”companion to ICD-10, but it has not been updatedsince publication in 1992. The next version of theparent classification system – ICD-11 – from the WorldHealth Organization expected for publication in2018 will have a similar, and up-to-date, companionpublication of clinical criteria and descriptions.ICD-10-CM codes contain up to seven characters. TheICD-10-CM codes are alphanumeric, and each codebegins with a letter – for example, F10.2. The lettercorresponds to the relevant chapter where the code isfound.Clinical psychologists are most likely to use Chapter5 — Mental, Behavioral and NeurodevelopmentalDisorders — where codes begin with the letter F. Healthpsychologists, neuropsychologists and others mightfind additional chapters important, such as Chapter 6,Diseases of the Nervous System (codes G00-G99). Allpsychologists will want to be familiar with Chapter 18,Symptoms, signs and abnormal clinical and laboratoryfindings, not elsewhere classified (codes R00-R99).Within each chapter, disorders are clustered togetherso that similar disorders have similar codes.Given its vastly expanded code list compared toICD-9-CM, the ICD-10-CM system allows for greaterspecificity in coding compared with its predecessor.In particular, the substance use disorder codes listedin Chapter 5 are more extensive than in ICD-9-CM.For example, F10.2 is Alcohol dependence, F10.23 isAlcohol dependence with withdrawal and F10.231 isAlcohol dependence with withdrawal delirium.Current Procedural Terminology (CPT ) copyright 2015 AmericanMedical Association. All rights reserved.1
ICD-10-CM ChecklistThe following checklist summarizes steps to review to be up-to-datewith ICD-10-CM coding.action steprelated details ownload the ICD-10-CM codes free of charge fromDthe Centers for Disease Control and Prevention (CDC)website. Be sure to download the current version as it isregularly updated. See the Additional Resources list on page 6 for details. Identify the ICD-9-CM codes you most commonly usein your practice and explore corresponding ICD-10-CMcodes. eep in mind that the appropriate choice of ICD-10-CMKcode ultimately needs to be considered for each patientencounter. See the Additional Resources on page 6for information about online tools that can assist withcomparing ICD-9-CM to ICD-10-CM codes. ake sure that all paper and electronic forms you use inMfiling claims for outpatient services contain the properICD-10-CM codes. M edicare and other payers will reject claims that containICD-9-CM codes, codes from DSM-IV or codes thatdon’t reflect the most recent updates. If you have been having problems with claim denials,check with any billing service, clearinghouse orelectronic health record (EHR)/practice managementsystem vendor you use to ensure they are using theproper ICD-10-CM codes. The “Road to 10” online resource noted in theAdditional Resources on page 6 contains a “TemplateLibrary” with lists of questions to ask.I f you have not yet done so, but are having problems,take advantage of training and system testing offered byany of the vendors you use and the third-party payerswith which you are affiliated. C heck vendor and payer websites for relevantinformation. Ensure that any staff who handle billing and claimsprocessing receive adequate training. Available sources include online courses, webinarsand even onsite training. Take advantage of trainingand educational resources offered by MedicareAdministrative Contractors (MACs) and other applicablepayers. For example, some MACs are offering webinarsto interested Medicare Part B providers. Check theirwebsites for details.APA Practice Organization apapracticecentral.org2
Crosswalk of ICD-9-CM to ICD-10-CM CodesUse this reference list to help you with coding for servicesnow that ICD-10-CM diagnostic codes are in effect.This crosswalk was developed to help members of theAPA Practice Organization. The list contains many of thefrequently used codes in the Mental, Behavioral andNeurodevelopmental Disorders section (Chapter 5) of theICD-10-CM classification system. The diagnoses listed belowcoincide with the wording in ICD-10-CM. These diagnosticnames may differ from those in the DSM-5.Attention Deficit / Hyperactivity n-Deficit / Hyperactivity Disorder314.00F90.0Predominantly inattentive type314.01F90.1Predominantly hyperactive type314.01F90.2Combined type314.01F90.8Other type314.01F90.9Unspecified typeDepressive DisordersICD-9-CMCodeICD-10-CMCodeDiagnosisSingle .2Severe without psychotic features296.24F32.3Severe with psychotic features296.25F32.4In partial Remission296.26F32.5In full remission296.20F32.9UnspecifiedRecurrent .2Severe without psychotic features296.34F33.3Severe with psychotic features296.35F33.41In partial remission296.36F33.42In full remission296.30F33.9Unspecified300.4F34.1Dysthymic disorderAPA Practice Organization apapracticecentral.org3
Common Anxiety DisordersICD-9-CMCodeICD-10-CM Code Diagnosis293.84300.21F06.4F40.01Anxiety disorder due to known physiological conditionAgoraphobia with panic disorder300.22F40.02Agoraphobia without F42.2F93.0Social phobia, generalizedPanic disorder without agoraphobiaGeneralized anxiety disorderObsessive-compulsive disorderSeparation anxiety disorder of childhoodBipolar 1.0Current episode hypomanicCurrent episode .13Severe without psychotic features296.44296.45296.46F31.2F31.73F31.74Severe with psychotic featuresIn partial remissionIn full remissionCurrent episode oderateSevere without psychotic featuresSevere with psychotic featuresIn partial remissionIn full remissionF31.31F31.32F31.4F31.5F31.75F31.76Autism Spectrum 4.0Autistic disorderAPA Practice Organization apapracticecentral.org4
Common Eating a nervosa307.1F50.01Restricting type307.1307.51307.51F50.02F50.2F50.81Binge-eating disorders307.50F50.9Eating disorder, unspecifiedBinge-eating / purging typeBulimia nervosaTrauma- and Stressor-Related 08.3309.81F94.1F43.0F43.10Reactive attachment disorder of childhoodAcute stress reactionPosttraumatic stress disorder, unspecifiedAdjustment .22F43.23F43.24F43.25F43.20309.89F43.8With depressed moodWith anxietyWith mixed anxiety and depressed moodWith disturbance of conductWith mixed disturbance of emotions and conductUnspecifiedOther reactions to severe stressPsychotic oid schizophreniaUndifferentiated schizophreniaSchizoaffective disorder, bipolar typeSchizoaffective disorder, depressive typeUnspecified psychosis not due to a substance or knownphysiological conditionAPA Practice Organization apapracticecentral.org5
Additional ResourcesAPA Practice OrganizationCenters for Disease Control and PreventionMembers of the APA Practice Organization have accessto a web-based application free of charge that providesinformation about the ICD-10-CM, featuring diagnosticcodes for Chapter 5. Users are able to navigate contentby searching for key words, by browsing a list of featuredICD-10-CM diagnoses or by exploring several graphicalinterfaces. Practice Organization members can use theapplication and access additional information aboutICD-10-CM. Go to the Practice Organization website(apapracticecentral.org), click on “Reimbursement”from the menu bar and then select “Diagnostic Coding &ICD.” You will be prompted to provide your membershipnumber.The ICD-10-CM Tabular List of Diseases and Injuriesavailable free of charge from the federal government.It is useful to download for handy regular reference. Itopens with a table of contents that lists the chapters inICD-10-CM and includes links to each. To download thislist, visit the Centers for Disease Control and Preventionweb page at cdc.gov/nchs/icd/icd10cm.htm, and followthese stepsAmerican Psychological AssociationA Primer for ICD-10-CM UsersThis spiral-bound book provides a helpful overview ofICD-10-CM and contains all of Chapter 5 (the F codesrelated to mental, behavioral and neurodevelopmentaldisorders) as an appendix. This is available at the APAwebsite at www.apa.org/pubs/books/; it also is availableas a Kindle version.A Student’s Guide to Assessment and DiagnosisUsing the ICD-10-CM: Psychological and BehavioralConditionsThis easy-to-read guide is useful for teaching studentsthe conceptual framework of the ICD-10-CM and itsapplication in assessment and diagnosis. Case examplesare used to illustrate diagnostic formulation as well asillustrating potential ethical and legal risk managementissues. www.apa.org/pubs/books/Centers for Medicare and Medicaid Serviceswww.cms.gov/ICD10The ICD-10 landing page on the Centers for Medicareand Medicaid Services (CMS) site features fact sheets,FAQs, checklists and other helpful resources. You can usethe link on this web page to sign up for e-mail updatesfrom CMS. Among the many resources available fromCMS is “Road to 10: The Small Physician Practice’s Routeto ICD-10” available online at www.roadto10.org. Whiletailored to “small physician practices,” this CMS resourcehas helpful information and guidance for other healthand mental health professionals, including practicingpsychologists. It Includes FAQs and videos, as well astemplates to use when reviewing ICD-10-CM readinesswith your billing service, clearinghouses and otheroutside vendors. “Road to 10” also includes questions toask payers with which you work.APA Practice Organization apapracticecentral.org Scroll down to “2017 release of ICD-10-CM” Click on “ICD-10-CM FY2017 Full PDF In the FTP Directory, click on ”icd10cm FY2017 FullPDF.zip” Click Open Click on “icd10cm tabular 2017.pdf”Note that fourteen mental health ICD-10-CM codeschanged on October 1, 2016. This crosswalk and a listof all the updated codes are available from the APAPractice Organization.Mobile Apps and Web-based CodeConversion ToolsNumerous online tools are available to assist healthand mental health professionals – for example,www.icd10data.com/Convert. If interested, go to theapp store for your platform (Apple, Android, etc.) andsearch for ICD-10-CM products. Check out the price andcustomer reviews for various options.Some of these apps and other web-based tools arefree; many more are available for a nominal fee, e.g.,less than 5. Keep in mind that, while the tools may behelpful, there are limitations to their use. An overrelianceon code conversion, or “crosswalk,” tools may result inchoosing incorrect codes, given the far more numerousICD-10-CM codes available compared to ICD-9-CM.Users should get in the habit of checking the results ofconversion tools against the complete list of ICD-10-CMcodes to ensure an appropriate degree of specificity intheir choice of code.6
Bipolar disorder ICD-9-CM Code ICD-10-CM Code Diagnosis 296.40 F31.0 Current episode hypomanic Current episode manic 296.41 F31.11 Mild 296.42 F31.12 Moderate 296.43 F31.13 Severe without psychotic features 296.44 F31.2 Severe with psychotic features 296.45 F31.73 In partial remission 296.46 F31.74 In full remission Current ep
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