What is the difference between DSM-5 and ICD-9?

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 17th, 2015

Both DSM-5 and ICD-9 codes are used for diagnosis and are exactly the same codes. For reporting purposes it is required to report ICD-9 codes to insurance payers. Most payers require ICD-9 codes to be billed on electronic or paper claims. Therefore, the codes are the same in DSM as in ICD-9, however keep in mind the descriptions may be different.

DSM uses a different pathway directing them to the code used for billing. DSM endorses most Behavioral health ICD-9 codes, however some ICD-9 codes are excluded in DSM-5.

The most important aspect of using DSM and ICD-9 is that the diagnosis supports the treatment and is medically necessary.

Everyone will be required to report diagnosis codes using ICD-10 starting October 2015.

Example:

DSM-IV

290.0  - dementia of the Alzheimer's type, with late onset, uncomplicated

290.10 - dementia due to Creutzfeldt -Jakob disease dementia due to Pick's disease dementia of the Alzheimer's type, with early onset, uncomplicated

ICD-9-CM

290.0   - senile dementia, uncomplicated

290.1   - presenile dementia

290.10 - presenile dementia, uncomplicated

References:

• Pimsyer.com