Friday, June 14, 2013

Government Issues FAQ Concerning DSM-5

In light of last month's publication of DSM-5, the federal government's Centers for Medicare and Medicaid Services (CMS) has clarified in the "Frequently Asked Questions" section of its Web site that it is appropriate for clinicians to use DSM-IV and DSM-5 to cross-walk to official HIPAA ICD-CM diagnostic code sets for Medicare and Medicaid claims, and to define these disorders for quality assessment, medical review, consultation, and patient communication. The following specific language in the FAQ makes the point that ICD-9-CM is the official HIPAA diagnostic code set for claims, although it does not have detailed information to define disorders for the additional functions described.

"The introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are 'compatible' with the ICD-9-CM diagnosis codes. The updated DSM-5 codes are crosswalked to both ICD-9-CM and ICD-10-CM. As of October 1, 2014, the ICD-10-CM code set [will be] the HIPAA-adopted standard and required for reporting diagnosis for dates of service on and after October 1, 2014.

"Neither the DSM-IV nor DSM-5 is a HIPAA-adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2014, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors, and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation, and patient communications."

APA has yet to determine the dates at which time it will recommend that government agencies and private insurers officially transition from using DSM-IV diagnoses to those in the new DSM-5. The CMS FAQ ends by referring readers to APA's DSM-5 Web site for additional information.

Information about purchasing DSM-5 and its companion guides is posted at


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