ICD-10 and DSM-5: Why all the fuss?

Things are definitely heating up in the ICD-10 world for us. That tells me the anxiety levels are increasing and people are starting to realize the ICD-10/DSM-5 transition is really going to happen. The stories, rumors, myths, and “decisions about proceeding” I am hearing are concerning. I have interacted with over 7,000 folks in the past few months and clearly the passions are heating up. Since the ICD-10/DSM-5 transition affects all areas of an organization, let me just share a few of the things I have encountered:

1. Many state Medicaid agencies (mental health/substance use divisions) are not prepared and need education on the ICD-10. While some states have already transitioned to DSM-5, others have not. To implement DSM-5 at the same time as ICD-10 is overwhelming. Add to that declarations that “We will only pay for a diagnosis that is included in the DSM-5” is misguided, at best. Who will end up paying the price? Provider organizations.
2. EHR Vendors are struggling just like everyone else. Have you taken a close look at what those drop-down menu’s reveal in your system? Do you understand the codes, the descriptions, and how certain codes ended up populating for that Search versus others? Can this be explained to you? More importantly, do your staff understand how it works? Significant effort needs to go into this aspect of the transition and End Users must be trained once the issues are sorted out.
3. “Just submit the DSM-5 diagnosis and we will convert it to ICD-10 for you.” This is a very scary statement, yet it is happening across the nation. This takes me back to the previous blog post I wrote, “Who Assigns ICD-10 Codes?” So, who is responsible for diagnosing, what is your source for that diagnostic code, and do you really want someone other than the responsible clinician assigning a diagnosis to your client? Who pays this price? Your consumer will when they receive a "mapped" diagnosis that was assigned by a third-party.
4. Some payers have started to issue declarations of what ICD-10 diagnoses they will pay for or not. This is not a new practice, but do you know what your payers are doing? My guess is that this list is short-sighted, and the payers will need long-term help to understand what you need on behalf of your clients.

The fuss is about anxiety and money. Running on thin profit margins as-is, we have little room in our bank accounts to put up with delayed or denied claims. Add to that an entire industry loaded with a lot of information (CMS, DSM, and ICD) and no true guidance on how to reconcile the matter puts providers in very difficult situations. The solution? Standardization in the industry:

• Begin teaching ICD in graduate schools. In early May, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) released its 2016 standards, and you'll see this standard in several programs: "diagnostic process, including differential diagnosis and the use of current diagnostic classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)."
• Insist that behavioral health is just as important, and on par with, the medical industry. To do this, we must tighten up our practices considerably. Behavioral health as the stepchild is partially our fault.
• Request clear leadership about the dilemma, and not from those with conflicted interests.
• At the very least, standardize across the organization how you deal with the dilemma.

Sometimes we have to be our own advocates.

Updated 6-2-2015.