DSM‑5‑TR Diagnoses, ICD‑10 Coding, and Billing Codes
Introduction
Accurate diagnosis, coding, and billing are essential components of modern healthcare. The DSM‑5‑TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) provides standardized criteria for psychiatric diagnoses. The ICD‑10 (International Classification of Diseases, 10th Revision) is the global standard for medical coding, used for both psychiatric and medical conditions. Billing codes, including CPT (Current Procedural Terminology) and ICD‑10 codes, ensure proper reimbursement, compliance, and documentation.
Together, DSM‑5‑TR, ICD‑10, and billing codes form the triad of clinical documentation:
DSM‑5‑TR → Diagnostic criteria.
ICD‑10 → Standardized diagnostic codes.
Billing codes → Financial reimbursement and administrative tracking.
1. DSM‑5‑TR Diagnoses
Overview
Published in 2022 as a revision of DSM‑5.
Adds Prolonged Grief Disorder as a new diagnosis.
Updates criteria for over 70 disorders.
Incorporates ICD‑10‑CM codes for suicidal behavior and nonsuicidal self‑injury.
Expands cultural considerations and addresses racism/discrimination in mental health.
Major Categories of DSM‑5‑TR Disorders
Neurodevelopmental Disorders
ADHD, Autism Spectrum Disorder, Intellectual Disability.
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia, Schizoaffective Disorder, Delusional Disorder.
Bipolar and Related Disorders
Bipolar I, Bipolar II, Cyclothymic Disorder.
Depressive Disorders
Major Depressive Disorder, Persistent Depressive Disorder, Prolonged Grief Disorder.
Anxiety Disorders
GAD, Panic Disorder, Phobias.
Obsessive‑Compulsive and Related Disorders
OCD, Hoarding Disorder, Trichotillomania.
Trauma‑ and Stressor‑Related Disorders
PTSD, Acute Stress Disorder, Adjustment Disorders.
Dissociative Disorders
Dissociative Identity Disorder, Depersonalization/Derealization Disorder.
Somatic Symptom Disorders
Somatic Symptom Disorder, Illness Anxiety Disorder.
Feeding and Eating Disorders
Anorexia Nervosa, Bulimia Nervosa, Binge‑Eating Disorder.
Sleep‑Wake Disorders
Insomnia, Narcolepsy, Sleep Apnea.
Sexual Dysfunctions
Erectile Disorder, Female Orgasmic Disorder.
Gender Dysphoria
Disruptive, Impulse‑Control, and Conduct Disorders
ODD, Conduct Disorder, Intermittent Explosive Disorder.
Substance‑Related and Addictive Disorders
Alcohol Use Disorder, Opioid Use Disorder, Gambling Disorder.
Neurocognitive Disorders
Delirium, Dementia.
Personality Disorders
Borderline, Antisocial, Narcissistic.
Paraphilic Disorders
Exhibitionistic, Voyeuristic, Pedophilic.
Other Conditions
Suicidal Behavior Disorder, Nonsuicidal Self‑Injury.
2. ICD‑10 Coding
Overview
Developed by the World Health Organization (WHO).
Used globally for disease classification, epidemiology, and billing.
In the U.S., ICD‑10‑CM (Clinical Modification) is used for diagnoses; ICD‑10‑PCS (Procedure Coding System) is used for inpatient procedures.
Structure of ICD‑10 Codes
Alphanumeric, 3–7 characters.
Example: F32.0 = Major Depressive Disorder, single episode, mild.
ICD‑10 Categories Relevant to Psychiatry
F01–F09: Organic, including symptomatic, mental disorders.
F10–F19: Mental and behavioral disorders due to psychoactive substance use.
F20–F29: Schizophrenia, schizotypal, and delusional disorders.
F30–F39: Mood (affective) disorders.
F40–F48: Neurotic, stress‑related, and somatoform disorders.
F50–F59: Behavioral syndromes associated with physiological disturbances.
F60–F69: Personality and behavioral disorders.
F70–F79: Intellectual disabilities.
F80–F89: Disorders of psychological development.
F90–F98: Behavioral and emotional disorders with onset in childhood/adolescence.
F99: Unspecified mental disorder.
3. Billing Codes
Overview
Billing codes ensure reimbursement and track services provided. They include:
ICD‑10‑CM codes: Diagnostic codes.
CPT codes: Procedure codes for services.
HCPCS codes: Supplies, equipment, non‑physician services.
Common CPT Codes in Psychiatry
90791: Psychiatric diagnostic evaluation.
90792: Psychiatric diagnostic evaluation with medical services.
90832: Psychotherapy, 30 minutes.
90834: Psychotherapy, 45 minutes.
90837: Psychotherapy, 60 minutes.
90839: Psychotherapy for crisis, first 60 minutes.
99213/99214: Outpatient office visits (evaluation and management).
Importance of Accurate Coding
Ensures proper reimbursement.
Prevents fraud and compliance issues.
Provides data for healthcare analytics.
Supports continuity of care.
4. Integration of DSM‑5‑TR, ICD‑10, and Billing Codes
How They Work Together
DSM‑5‑TR provides diagnostic criteria.
ICD‑10 provides standardized diagnostic codes.
Billing codes (CPT/HCPCS) document services provided.
Example
Patient diagnosed with Major Depressive Disorder:
DSM‑5‑TR criteria: Persistent sadness, loss of interest, ≥2 weeks.
ICD‑10 code: F32.1 (MDD, moderate).
CPT code: 90834 (psychotherapy, 45 minutes).
5. Challenges and Considerations
Complexity: Matching DSM‑5‑TR criteria with ICD‑10 codes can be challenging.
Updates: Frequent revisions require ongoing education.
Compliance: Incorrect coding can lead to audits and penalties.
Cultural sensitivity: DSM‑5‑TR emphasizes cultural formulation in diagnosis.
Technology: EHR systems must integrate DSM‑5‑TR, ICD‑10, and billing codes seamlessly.
6. Case Study Example
Scenario:
Patient presents with symptoms of PTSD.
DSM‑5‑TR: Meets criteria for trauma exposure, re‑experiencing, avoidance, hyperarousal.
ICD‑10: F43.10 (Post‑traumatic stress disorder, unspecified).
Billing: 90791 (psychiatric diagnostic evaluation) + 90834 (psychotherapy, 45 minutes).
Outcome: Accurate documentation ensures proper treatment planning and reimbursement.
7. Summary of Key Points
DSM‑5‑TR provides criteria for psychiatric diagnoses.
ICD‑10 provides codes for diagnoses.
Billing codes (CPT/HCPCS) provide codes for services.
Integration of all three ensures accurate diagnosis, documentation, and reimbursement.
Clinicians must stay updated on revisions to maintain compliance and quality care.
Quiz: DSM‑5‑TR Diagnoses, ICD‑10 Coding, and Billing Codes
Multiple Choice
Which new disorder was added in DSM‑5‑TR?
a) Hoarding Disorder
b) Prolonged Grief Disorder
c) Social Anxiety Disorder
d) Cyclothymic Disorder
ICD‑10 code F32.0 refers to:
a) Schizophrenia
b) Major Depressive Disorder, mild
c) Bipolar I Disorder
d) Generalized Anxiety Disorder
Which CPT code is used for a psychiatric diagnostic evaluation?
a) 90834
b) 90791
c) 99213
d) 90837
DSM‑5‑TR criteria for PTSD include all EXCEPT:
a) Trauma exposure
b) Re‑experiencing
c) Elevated mood
d) Hyperarousal
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