To make the transition from ICD-9 to ICD-10 somewhat easier no deletions, additions or wording changes were allowed to the ICD-10 formalized several years ago. However, the moratorium has run its course and changes to the diagnoses and code numbers to be used for documentation and billing for services rendered after Oct. 1 were recently finalized by the National Center for Health Statistics at the Center for Disease Control.
Recall that DSM-5 adopted about half of the codes (numbers) available in the ICD’s F-codes (the familiar symptom-based disorders) although the American Psychiatric Association (APA) changed the names of about a dozen of them. Now all the changes to ICD for 2017 are wordings adopted from the DSM-5.
The good news is that there are fewer than 20 of these and their names have been widely discussed (e.g. Disruptive mood dysregulation disorder, Excoriation disorder, Social pragmatic communication disorder. Hoarding disorder was already in ICD). Do note that ICD-10 retained and still retains many of the older diagnoses from ICD-9 such as Conduct disorder and Asperger’s.
The bad news is that more than 100 of DSM-5’s wordings for substance use, abuse, dependency, etc. diagnoses have now been added to the diagnoses already in ICD. I am not an expert in this area but based on my reading of the DSM’s wordings, I do not see any meaningful improvement by their addition. I do not see any added information, important distinctions or clarity of concepts in them. They simply expand the bulk of the text file. They are not improvements because DSM’s concepts are often muddled and not an improvement over the traditional and familiar wordings of ICD. For example does DSM’s “mild” equal or improve on ICD’s “uncomplicated” substance abuse?
As context to understanding what this adoption means recall that ICD is simply the results of a multinational, multi-cultural and historical survey of which diagnostic labels are in actual use by clinicians of different backgrounds, training and experience around the world. Its main purpose is to document practice and so it does not contain diagnostic criteria, epidemiological data or other discussions present in DSM.
In contrast, DSM claims to document real disorders (not diseases) and that their etiology and dynamics are at least partially known and offered. The ICD is international and not just American in its concepts, language and private sponsorship. Having the World Health Organization adopt DSM language into ICD guarantees DSM’s use (sales) and influence around the world. It is hegemony if not imperialism.
This “harmonization” of two quite differently designed and purposed sets of diagnoses is, at its base, a power grab by the APA. In the absence of a diagnostic manual for the ICD the APA has integrated enough of DSM’s language into the ICD so that the book will now become the necessary reference for understanding the meanings of the diagnostic labels. I don’t need to restate for this audience the significant scientific failings of the DSM-5.
What to do now
The good news is that this does not change the codes (numbers) to be used in our records and billing. Use your current ICD codes for services you provide up until the end of September. Use them even if you bill for those services after that date. For services you provide (and bill for) after Oct. 1, use the changed codes described here.
If you need to add the diagnostic labels for your documentation there is no guidance as to using the older ICD language or the now added DSM language – or both. Sorry. Perhaps our friends at the managed care companies will tell us what they want. In my opinion, you can’t go wrong with the ICD words as they are from the U.S. government-approved list.
You can hack your copy of the DSM-5 to include the newly introduced diagnoses. This idea was suggested by Todd Finnerty, Psy.D., and his list is on his website at: http://psychology.news/news/
I will soon be incorporating all changes to ICD in the version I sell on my website and will offer some way to update copies you have bought from me.
And just one last point: the new diagnoses are only to the F-codes (Chapter 5 of ICD-10). No changes were made to any of the S, T, R or Z codes all of which I believe should be considered in creating any comprehensive biopsychosocial case formulation.
Ed Zuckerman, Ph.D., is a clinical psychologist licensed in Pennsylvania and the author of the Clinician’s Thesaurus whose eighth edition will come out in the spring and of The Paper Office for the Digital Age whose fifth edition (co-authored with Keely Kolmes, Psy.D.) will be out this fall. He has offered for sale a more functional and handy version of the ICD-10 at his website (www.TheCliniciansToolbox.com) for the last three years along with some informative handouts about ICD and DSM.