DSM-IV-TR Is HIPAA Compliant
Psychiatrists can continue to use the diagnostic codes listed in the most recent edition of DSM-IV-TR and be HIPAA compliant. The Office of Healthcare Systems and Financing has received a number of calls from concerned psychiatrists about HIPAA-compliant diagnostic coding. Although the HIPAA regulations identify the ICD-9-CM as the numerical code set for diagnostic coding by all physicians, psychiatrists can continue to use the DSM-IV-TR code sets because the ICD-9-CM and the DSM-IV-TR are 99.9% identical.
The International Classification of Diseases (ICD) code set has been in place for more than 40 years and has been the standard diagnostic code set for inpatient services, as well as for Medicare services. APA monitors any changes to the ICD and incorporates these into each new edition of DSM. The latest edition, DSM-IV-TR, reflects all the coding changes to the ICD-9-CM except the following, which occurred after publication:
• The DSM-IV-TR code for age-related cognitive decline has been changed from 780.9 to 780.93.
• Two changes in diagnostic codes reflect changes in general medical condition codes that have an impact on DSM-IV-TR coding. They are
| •. | Dementia due to Parkinson’s disease: on Axis III, one should now code 331.82 dementia with Lewy bodies. | ||||
| •. | Dementia due to Pick’s disease: on Axis III, one should now code 331.11 Pick’s disease. | ||||
• Appendix G in DSM-IV-TR includes “ICD-9-CM Codes for Selected General Medical Conditions and Medication-Induced Disorders.” Changes in ICD-9-CM codes for general medical conditions have necessitated the following updates:
| •. | Encephalopathy, unspecified, is now 348.30 | ||||
| •. | Myasthenia gravis is now 358.00 | ||||
| •. | Pick’s disease is now 331.11 | ||||
| •. | Dwarfism, pituitary, is now 253.3 | ||||
| •. | Hyperaldosteronism is now 255.10 | ||||
| •. | Diverticulitis of colon, unspecified, is now 562.11 | ||||
| •. | Diverticulitis of colon, with hemorrhage, is now 562.13 | ||||
| •. | Diverticulosis of colon, unspecified, is now 562.10 | ||||
| •. | Diverticulosis of colon, with hemorrhage, is now 562.12 | ||||
| •. | Hypertrophy, prostatic, benign (BPH), is now 600.00 | ||||
| •. | Thalassemia is now 282.49 | ||||
The next edition of DSM will include these and any other changes. APA will continue to update the diagnostic codes in subsequent printings of DSM-IV-TR to remain compatible with the ICD system.
APA members who believe that their claims have been rejected because of an ICD-9-CM issue should contact the Office of Healthcare Systems and Financing’s Help Line at (800) 343-4671.
