2013 and 2014 have proven to be “shake up” years for diagnostic and procedure coding for behavioral health services. Effective January 1, 2013, there were significant changes to Current Procedural Terminology (CPT) codes for psychiatry and psychotherapy services. A few months later in May, the American Psychiatric Association released the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Effective October 1, 2015 (an unexpected one year delay), the entire U.S. healthcare system will transition to using the new ICD-10-CM code set.
Collectively, these transitions impact clinical diagnoses, billing, contracts, work flow, HIT, compliance protocols, and more. Explore the resources included below to help you navigate these changes.
Procedure Codes: CPT Changes to Psychiatry and Psychotherapy Services
- National Council’s fact sheet with crosswalk (3/7/13)
- AACAP’s Interactive Complexity Guide for use of +90785, the new add-on code for interactive complexity
- National Council’s Compliance Watch series on CPT
- Evaluation and Management Codes:
- CMS 1997 Evaluation and Management Guidelines
- “Coding for Key Components” guide by the AACAP
- CPT Code Changes for 2013: Impact on Behavioral Health – November 9, 2012
- E/M 101: Preparing Your Organization for 2013 CPT Code Changes – December 3, 2012
- CPT Code Changes: E/M 102, Level Selection and Documentation Support – January 9, 2013
Diagnostic Codes: DSM-5 and ICD-10-CM
The DSM-5 is the primary source used by clinicians for behavioral health diagnoses, but the ICD-10-CM code set is required for reporting and claim submissions. Behavioral health organizations need to have the work flow and technology supports in place to support accurate diagnostic reporting.
- American Psychiatric Association Webinar: Transitioning to DSM-5 and ICD-10-CM—visit this link to create a free account on the American Psychiatric Association education website. Once created, you can select “Course Catalog” under your name, and scroll down to their DSM-5 series. Select view, then select the “Transitioning to DSM-5 and ICD-10-CM” course and click register. Once you have registered you will find the course under “MY COURSES.” Click the red launch course button to begin.
- ICD-10 The Next Generation of Coding
- ICD-10 Myths & Facts
- ICD-10 Classification Enhancements
- Transition to ICD-10: Countdown to October 1, 2015
- The ICD-10 Classification of Mental and Behavioural Disorders Clinical Descriptions and Diagnostic Guidelines, sometimes referred to as the “Bluebook,” this guide includes clinical descriptions and diagnostic guidelines of the ICD-10 by the World Health Organization
- Understanding ICD-10-CM and DSM-5: A Quick Guide for Psychiatrists and Other Mental Health Clinicians, by the American Psychiatric Association
- DSM-5 Implementation and Support by the APA
- CMS Resource page, including official resources designed for providers, and education modules for small practices.
- E-learning courses by Relias Learning on DSM-5
- “Transitioning to ICD-10: Why It’s Important to Behavioral Health Care Providers and How to Prepare” – Elinore McCance-Katz, Joseph Nichols, and Donna Pickett, January 24, 2014. Slides
- “Preparing Your Organization for ICD-10 Implementation,” Michael Flora and David Swann, February 2014. Slides
- “ICD-10 is Delayed: Now What?” – Nina Marshall, and David Swann, June 2, 2014. Slides
Looking for training and support? Check out the National Council’s consulting services.
The National Council is providing these resources to help behavioral health organizations transitions to the new CPT, DSM, and ICD code sets. The information provided should not be considered a substitute for professional or legal advice on compliance matters.
CPT® five-digit codes, descriptions, and other data only are copyright 2012 by the American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT®. CPT® is a registered trademark of the American Medical Association (AMA).
DSM-5 is a registered trademark and protected by copyright held by the American Psychiatric Association.