DSM 5 AND ICD-10

Countdown to Change: #3 of 6

A MEMBERSHIP BENEFIT:NEW YORK STATE COUNCIL FOR COMMUNITY

BEHAVIORAL HEALTHCAREMarch 16, 2015

Compliance Consortium Presentation

HELLO from Derek

Board Certified Fraud Examiner (CFE): Association of Certified Fraud

Examiners

Medical Investigator (CMI-V): American Board of Forensic Medicine

For the past 40 years: Special Investigator

Provider/Administrator

Auditor/Consultant/Author

Speaker/Trainer

PhD – Forensic Psychology

Masters – Health Administration

Fellow - American Board of Forensic Examiners

Association of Certified Fraud Examiners Advisory Council 3

DrDJ@Diligence.pro

Today’s Discussion

• Update on Transition Deadline

• How DSM changes things and How

DSM 5 will help me transition to ICD

10 (recap)

• From IV to 5: Highlights of Specific Disorder Revisions

Slides and recording available at

www.nyscouncil.org

HOW DSM 5 CHANGES THINGS

How DSM 5 changes things

DSM-5 – non-axial documentation of diagnosis.Axis III – combined with Axes I and II; physical healthconditions are to be listed.

Axis IV – eliminated; psychosocial and environ-mental issues – use ICD- 9 V codes and ICD-10 ZCodes.

Axis V GAF – eliminated; scale developed byWHO (WHODAS) is recommended by DSM-5task force – best global measure of disability.

How DSM 5 changes things

• DSM-5 organized by the developmental lifespan

– Neurodevelopmental disorders in childhood

– Neurocognitive disorders in older adulthood

• Restructuring of chapters based on disorders’ relatedness to one another

• Restructuring based on symptom vulnerabilities andsymptom characteristics

How DSM 5 changes things

1. Neurodevelopmental Disorders

2. Schizophrenia Spectrum and Other

Psychotic Disorders

3. Bipolar and Related Disorders

4. Depressive Disorders

5. Anxiety Disorders

6. Obsessive-Compulsive and Related

Disorders

7. Trauma- and Stressor-Related Disorder

8. Dissociative Disorders

9. Somatic Symptom Disorders

10. Feeding and Eating Disorders

11. Elimination Disorders

12. Sleep-Wake Disorders

13. Sexual Dysfunctions

14. Gender Dysphoria

15. Disruptive, Impulse Control and Conduct

Disorders

16. Substance-Use and Addictive Disorders

17. Neurocognitive Disorders

18. Personality Disorders

19. Paraphilic Disorders

20. Other Disorders

HOW DSM 5 WILL HELP THE TRANSITION FROM ICD-9 TO ICD-10

DSM 5

DSM-5 contains all of the information needed to assign HIPAA-compliant, valid ICD-10-CM codes to the psychiatric diagnoses that you make for your patients.

DSM-5 training can be helpful to clinicians. Training dedicated solely to ICD-10-CM is usually aimed at administrators, information technology specialists, and coding professionals.

DSM 5

The ICD-10-CM codes are alpha-numeric. In DSM-5, they can be found in parentheses within the diagnostic criteria box for each disorder.

DSM 5

If more than one code can be assigned to a disorder, the codes can be found at the bottom of the diagnostic criteria box. This will appear in the DSM-5 criteria as below:

DSM 5

Coding Notes:

HIGHLIGHTS OF SPECIFIC DISORDER REVISIONS:

DIAGNOSTIC CRITERIA AND CODES

Neurodevelopmental Disorders

Autism Spectrum Disorder (ASD) replaces Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder, etc.

Specifiers describe variants of Autism Spectrum Disorder.

Former diagnosis of Asperger’s Disorder can now be diagnosed as Autism Spectrum Disorder, without intellectual impairment and without structural language impairment.

Intellectual Disability

The term “Intellectual Disability” replaces “Mental Retardation.”

Attention-Deficit/Hyperactivity DisorderAge of onset was raised from 7 years to 12 years.

Specific Learning Disorder now presented as a single disorder

Schizophrenia and Other Psychotic Disorders

Schizophrenia Spectrum and Other Psychotic Disorders

• Schizotypal (Personality) Disorder 301.22 (F21)

• Delusional Disorder 297.1 (F22)

• Brief Psychotic Disorder 298.8 (F23)

• Schizophreniform Disorder 295.40 (F20.81)

• Schizophrenia 295.90 (F20.9)

• Schizoaffective Disorder (bipolar or depressive type) 295.70 (F25.0, F25.1)

• Substance/Medication-Induced Psychotic Disorder – see substance- specific

codes

• Psychotic Disorder Due to Another Medical Condition (with delusions or with hallucinations) 293.81, 293.82 (F06.2, F06.0)

Schizophrenia Spectrum and Other Psychotic Disorders

• Catatonia Associated with Another Mental Disorder 293.89 (F06.1)

• Catatonic Disorder Due to Another Medical Condition293.89 (F06.1)

• Unspecified Catatonia 293.89 (F06.1)

• Other Schizophrenia Spectrum and Other Psychotic Disorder (other specified or unspecified) 298.8 (F28)

Schizophrenia Spectrum and Other Psychotic Disorders

Symptom criteria changes:

Schizophrenia

Criterion A lists the five key symptoms of psychotic disorders: 1) delusions, 2) hallucinations, 3) disorganized speech, 4) disorganized or catatonic behavior, and 5) negative symptoms.

Schizoaffective

Schizoaffective disorder forms a link between psychosis and mood.

Delusional Disorder:

The requirement that delusions be non-bizarre has been removed

Bipolar and Related Disorders

Bipolar and Related Disorders Categories

• Bipolar I Disorder 296.40-296.46 (F31 series), 296.50-56 (F31 series)

• Bipolar II Disorder 296.89 (F31.81)

• Cyclothymic Disorder 301.13 (F34.0)

• Substance/Medication-Induced Bipolar and Related Disorder – see substance abuse section

• Bipolar Disorder Due to Another Medical Condition 293.83 (F06.33, F06.34)

• Other Bipolar and Related Disorder 296.89 (F31.89)

• Unspecified Bipolar and Related Disorder 296.80 (F31.9)

Other changes: Bipolar and Related Disorders Categories

Bipolar Disorders

To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood.

Other Specified Bipolar and Related Disorder

DSM-5 allows the specification of particular conditions for other specified bipolar and related disorder

Anxious Distress Specifier

In the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for anxious distress is delineated.

Bipolar and Related Disorders and Depressive Disorders

Bipolar and Related Disorders

Mania and Hypomania Criterion A now includes increased energy/activity as a required symptom.

“Mixed episode” is replaced with a “with mixed features” specifier.

“With anxious distress” was added as a specifier for bipolar and depressive disorders.

Depressive Disorders

The bereavement exclusion was eliminated from major depressive episode (MDE).

Disruptive Mood Dysregulation Disorder (DMDD) was added.

Dysthymic Disorder was renamed Persistent Depressive Disorder.

The Anxiety Disorders

DSM-5 has four chapters covered by two chapters in DSM-IV.

Anxiety Disorders

Obsessive-Compulsive & Related Disorders

Trauma- & Stressor-Related Disorders

Dissociative Disorders

1. Anxiety Disorders Panic attacks was added as a specifier for any mental disorder.

Panic attacks can occur in many mental disorders.

2. OCD and Related D/O Hoarding Disorder was added.

Excoriation (Skin-Picking) Disorder was added.

The Anxiety Disorders, cont’d

3. Trauma- & Stressor-Related Disorders Posttraumatic Stress Disorder

Multiple changes

4. Dissociative Disorders Text was added to support Criterion D.

Dissociative fugue now a specifier for any dissociative disorder.

Somatic Symptom and Related Disorders

The emphasis is placed on disproportionate thoughts, feelings, and behaviors that accompany symptoms, rather than on whether the symptoms are medically unexplained.

Somatic Symptom Disorder replaces somatoform disorder, hypochondriasis, and the pain disorders.

Feeding and Eating Disorders

Binge Eating Disorder (BED) is new.

Anorexia Nervosa no longer requires amenorrhea.

Sleep-Wake Disorders

Primary Insomnia now Insomnia Disorder.

Rapid Eye Movement Sleep Behavior Disorder and Restless Legs Syndrome

Subtypes expanded for Circadian Rhythm Sleep Disorders.

Gender Dysphoria

Newly added

Replaces Gender Identity Disorder.

Focuses on the dysphoria.

Disruptive, Impulse-Control, and Conduct Disorders

Conduct Disorder

Added a specifier “with limited prosocial emotions.”

Intermittent Explosive Disorder

Provides more specific criteria to define outbursts.

Substance-Related and Addictive Disorders

Substance Use Disorder (SUD)

Substance abuse and substance dependence are combined.

Severity rated as mild, moderate, or severe.

Craving added as a new criterion

Legal consequences was removed as a criterion.

Cannabis withdrawal is a new disorder.

Caffeine withdrawal is a new disorder.

Non-Substance-Related Disorders

Gambling Disorder

Internet Gaming Disorder is included in Chapter 3 as a “condition for further study.”

No other behavioral addictions are mentioned.

Neurocognitive Disorders

The word dementia was eliminated; the new term is Major Neurocognitive Disorder.

The word “Dementia” linked to old age diseases; and

Clinicians tended to be pessimistic about its prognosis.

Mild Neurocognitive Disorder is new.

Neurocognitive decline is not inevitable.

Adjustment Disorders

The chapter “Adjustment Disorders” incorporated into Trauma- and Stressor-Related Disorders

Criterion B-1 was rephrased as “marked distress that is out of proportion to the severity or intensity of the stressor.”

Personality Disorders

All 10 PDs in DSM-IV remain intact in DSM-5.

Note that “Axis II” in DSM-IV no longer exists.

DSM-5 contains an alternate, trait-based approach to assessing personality

Alternate Model for PDs

Characterized by impairments in personality functioning and pathological personality traits.

General Criteria for Personality Disorder

Specific Personality Disorders

Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-Compulsive, and Schizotypal.

PD but not one of the 6 types above.

Impairment in personality functioning.

Pathological personality trait domains.

Paraphilic Disorders

Disorders rather than paraphilias.

Do not involve non-consenting victims are not necessarily a mental disorder.

To have this disorder requires: distress,

impairment, or

abuse of a non-consenting victim.

Other Conditions That May Be A Focus of Clinical Attention

The list of “V-Code” and other conditions was expanded to 134 separate conditions.

Emerging Measures and Models

Optional Assessment Measures Level 1 Cross-Cutting Symptom Measure

Level 2 Cross-Cutting Symptom Measure

Diagnosis-Specific Severity Measures To document the severity of a specific disorder.

Some are clinician-rated, some are patient-rated.

WHO Disability Assessment Schedule 2.0

Cultural Formulation

Conditions for Further Study

Attenuated Psychosis Syndrome

Persistent Complex Bereavement Disorder

Caffeine Use Disorder

Internet Gaming Disorder

Suicidal Behavior Disorder

Nonsuicidal Self-Injury

Next time: #4. Complete the chapters (Differences from IV to 5) #5. Simple cross from DSM 5 to ICD 10: Need to Know only #6. Readiness Indicator and Answering Questions

Written questions can go to:

DrDJ@Diligence.pro

EMR screen shots with permission and courtesy of Valant Medical Solutions - www.Valant.com

NCBH Natcon 2015 - Booth #631http://valant.com/ncbh-meeting-request/

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