TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 174 ICD coding . Since publication of the DSM-III , ICD-9 codes have appeared next to each diagnostic classification (APA, 1980). Originally created for statistical tracking of diseases, not reimbursement, most medical systems within the United States use these codes for billing purposes. These codes are also required for use by medical insurance organizations by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In the DSM-5 (APA, 2013), ICD-9 codes are in black print, appear first, and typically include three digits or begin with V . In contrast, ICD-10 codes are gray in print, appear in parentheses, and generally begin with the letter F or, if representing psychosocial or environmental factors, with the letter Z . The reason for including both coding sets in the DSM-5 is that all practitioners must align with HIPAA, which requires use of ICD-10-CM (clinical modification) codes no later than October 1, 2015. Complete ICD-9 and ICD-10 codes can be found in the Appendix of the DSM-5 , listed alphabetically and numerically. The implication of this modification is relatively minor for counselors. Counselors should be aware that the initial printing of the DSM-5 contained several coding errors, and not all terminology used within the DSM-5 matches ICD-10 exactly. Counselors can obtain a printable desk reference with coding updates by visiting the DSM-5 coding update section on the website (APA, n.d.). Specifiers and subtypes. In keeping with a dimensional philosophy, the DSM-5 (APA, 2013) contains an expanded listing of specifiers and subtypes for disorders listed throughout the manual. As noted previously, this update may include a greatly expanded number of options to denote experience within a diagnosis. For example, counselors may now add the specifier with panic attacks to any diagnosis within the DSM-5 . Other important changes include an expanded listing of specifiers for bipolar and related disorders and depressive disorders, such as with catatonia , with anxious distress , and with mixed features . These specifiers are intended to account for experiences that are often present in both types of disorders, such as elements of anxiety, but may not be part of the general criteria for the disorders (APA, 2013). Counselors should note all relevant specifiers for each diagnosis. For more information regarding specifiers and subtypes, professional counselors can refer to the DSM-5 for specific coding instructions and examples (APA, 2013). Despite these changes, most situations will require counselors to use the same diagnostic codes regardless of subtypes and specifiers assigned (APA, 2013; Dailey et al., 2014). There are some exceptions, however, such as when recording substance-related disorders. Insurance Transitions The APA (2013) noted that the DSM-5 was “developed to facilitate a seamless transition into immediate use by clinicians and insurers to maintain a continuity of care” (p. 1). Counselors may begin using diagnostic criteria as soon as they are ready to do so. Insurance companies, other third-party payers and mental health agencies, however, may take additional time to adjust their reporting systems from ICD-9 to ICD-10 . This is especially true for the transition from a multiaxial to a nonaxial format (Dailey et al., 2014). Although many counselors used the multiaxial system for diagnostic decisions, conversations and reimbursement, elimination of this system should not impact treatment decisions or reimbursement. Many third- party billing systems and government agencies collected data regarding a specific diagnosis only (previously Axis I, II and III); therefore, with the transition they should simply be reporting the same type of information. Some insurance panels and reimbursement systems may have previously required more information, such as a GAF score, when determining eligibility for services. Given the expansion of severity indicators and specifiers contained throughout the DSM-5 , functional impairments or specific disabilities may be noted within the nonaxial diagnosis. If this is not the case, as mentioned previously, counselors may use narrative notations alongside diagnostic labels. To the extent that functional impairment or disabilities are not listed and would