The purpose of this information letter (IL) is to provide information and guidance on the use of Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), when submitting the International Classification of Diseases, Version 10 (ICD-10) diagnosis codes in Field 27 of the Intellectual Disability/Related Condition (ID/RC) Assessment (Form 8578).
Effective October 1, 2015, the Centers for Medicare and Medicaid Services (CMS) will require healthcare providers and governmental entities to transition from ICD-9 to ICD-10. The Department of Aging and Disability Service (DADS) notified program providers about this transition in IL 15-42 and IL 15-43.
As referenced in IL 15-42 and IL 15-43, all ID/RC Assessments with effective dates on or after October 1, 2015, must be submitted with ICD-10 codes only. ID/RC Assessments with multiple diagnoses must be submitted using diagnosis codes based on ICD-10.
Guidance released by CMS, in response to questions about clinical practice and use of the DSM- IV and DSM-5 diagnostic criteria (FAQ #1817) states:
“ICD-9-CM codes should be used for reporting the diagnosis codes associated with services furnished up to, and including, September 30, 2015. As of October 1, 2015, the ICD-10-CM code set will become the HIPAA adopted standard and will be required for reporting diagnosis codes for dates of service on and after October 1, 2015. The DSM-5 contains the standard criteria and definitions of mental disorders now approved by the American Psychiatric Association (APA), and it also contains both ICD-9-CM and ICD-10-CM codes (in parentheses) selected by APA. Since DSM-IV only contains ICD-9-CM codes, it will cease to be recognized for criteria or coding for services with dates of service of October 1, 2015 or later.”
Diagnosis codes entered in Field 27 (psychiatric code) of the ID/RC Assessments must reflect the version of the DSM, as represented in Field 28, Version 5.
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