Monday, April 15, 2013

APA Answers Insurance-Related Questions About DSM-5

Today, APA posted questions and answers regarding the insurance implications of DSM-5. One frequent question, for example, is: When can DSM-5 be used for insurance purposes? The answer is the following: "Since DSM-5 is completely compatible with the HIPAA-approved ICD-9-CM coding system now in use by insurance companies, the revised  criteria for mental disorders can be used immediately for diagnosing mental disorders when it is released in May 2013. However, the change in format from a multiaxial system in DSM-IV-TR may result in a brief delay while insurance companies update their claim forms and reporting procedures to accommodate DSM-5 changes."

Another common question is: How are DSM-5 and ICD related? Here is the answer: "DSM-5 and the ICD should be thought of as companion publications. DSM-5 contains the most up-to-date criteria for diagnosing mental disorders, along with extensive descriptive text, providing a common language for clinicians to communicate about their patients. The ICD contains the code numbers used in DSM-5 and all of medicine, needed for insurance reimbursement and for monitoring of morbidity and mortality statistics by national and international health agencies..."

Yet a third frequent inquiry is: Can clinicians continue to use the DSM-IV-TR diagnostic criteria? The answer is: "Clinicians may use DSM-5 in their practices starting in May, when the manual is released. However, there may be brief delays while insurance companies update their claim forms and reporting procedures to accommodate DSM-5 changes, and clinicians should use DSM-IV-TR diagnoses and codes when required by a specific company. Transition details are still being developed with CDC-NCHS, CMS, and private insurance agencies. APA is working with these groups with the expectation that a transition to DSM-5 by the insurance industry can be made by December 31, 2013."

To read all the questions and answers that have been posted on the subject, visit this link.


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