How To Get Your Behavioral Health Codes Right

According to CMS, “…neither the DSM-IV nor the DSM-5 is a HIPAA Compliant code set. Therefore Behavioral Health specialists must use ICD-9 CM codes and after October 1, 2014 the appropriate ICD-10 CM diagnosis code.”

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How To Get Your Behavioral Health Codes Right

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Cristina Medina

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How to get your behavioral health codes right

In the mental health field, many psychiatric clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and since May 19, 2013 the updated DSM-5 for diagnosing mental disorders. Psychiatric specialists have knowledge and a comfort level with the DSM for clinical decision making. When planning for ICD-10, it is important to understand CMS policy on the matter. According to CMS, neither the DSM-IV nor the DSM-5 is a HIPAA Compliant code set. Therefore Behavioral Health specialists must use ICD-9 CM codes and after October 1, 2014 the appropriate ICD-10 CM diagnosis code. For inpatient procedures, ICD-10 PCS must also be used, and for ambulatory procedures, ICD10 CM diagnosis must be paired with CPT codes. Do Fewer Codes for Behavioral Health Mean Less Complexity and an out from doing a proper ICD-10 Assessment? No. Heres Why. There are relatively few increases in ICD-10 codes in behavioral health relative to high impact specialties such as Orthopedics. For example, there are 27 ICD-9 codes for Anxiety Disorders and 47 codes under ICD-10. Schizophrenia codes are reduced from 56 in ICD-9 to 11 in ICD10. Therefore, some behavioral health providers assume in error that because there are fewer codes that the ICD-10 transition has little impact on their organization, which is not true. Because DSM is used for clinicians and ICD-10 for reimbursement, there is an increased level of complexity. Local and state requirements regarding the use of DSM and ICD-10 vary, which then causes you to consider: Eliminate DSM if not required in your state? Map or crosswalk from DSM-IV to DSM-5 to ICD-10?

Some Behavioral specialty providers recently stated we dont use DRGs we useInpatient Psychiatric Facility Prospective Payment System (IPF PPS). In fact the facility is using DRGs. According to CMS, IPF PPS, Federal per diem rates include inpatient operating and capitalrelated costs (including routine and ancillary services) and are determined based on: Geographic factors: o A hospital wage index value is assigned to account for geographic differences in wage o The non-labor-related portion accounts for higher cost of living for IPFs located in Alaska and Hawaii; Patient characteristics: o Medicare Severity-Diagnosis Related Group (MS-DRG) classification; o Age; o Presence of specified comorbidities; and Length of stay; and Facility characteristics:

How to Successfully Transition Behavioral Health Organizations to ICD-10 o Ensure that you hire, or retain consulting expertise knowledgeable in DSM-5 and the purpose and usage of these codes throughout the mental health specialty organization and physician group. o Ensure proper knowledge transfer to your coding, billing, clinical and operations staff. o Consider patient referral documentation and its impact on your reimbursement, and ensure that non-employed physicians as a source of referral are engaged as much as possible. o Identify those departments that are using DSM codes. o Determine if the codes being used are DSM-4 or DSM-5. o Evaluate patient intake systems, reporting, and more for DSM-4 or ICD-9 specific dependencies o Consider payor contracting factors. Even if your payor contracts are per-diem or if you have self-pay clients, you must consider the reporting and potential audit risk if you do not use the HIPAA required ICD-10 codes. o Understand how these requirements impact your IT systems: o Consider the specificity of clinical documentation that your HIM systems support. If you use an Electronic Medical Record, determine whether it supports the proper level of specificity in the DSM (if it is required by your State or local laws) and the specificity to support ICD-10. o Determine what impact these changes have on your revenue cycle management systems and processes. o In a recent engagement with a regional free standing Behavioral health provider, we determined that at least forty (40) processes related to RCM are impacted.