DSM-5 and ICD-10 Resources

In response to legislation passed on April 1, 2014 which delayed the ICD-10 implementation mandate, we revised plans and timelines related to the ICD-10 implementation and continued with the implementation of DSM-5 on October 1, 2014. CMS announced that the U.S. Department of Health and Human Services issued a rule on July 31, 2014 stating that ICD-10 implementation will occur October 1, 2015.

Optum Timeline

• ICD-10 implementation on October 1, 2015: Use DSM-5 diagnostic criteria and labels, use ICD-10 billing codes associated with the DSM-5 conditions
• DSM-5 implementation on October 1, 2014: Use DSM-5 diagnostic criteria and labels, use ICD-9 billing codes associated with the DSM-5 conditions

In addition to providing diagnostic criteria, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) includes mapping to ICD billing codes. Below are resources to assist with the transition. Your use now of the DSM-5 will support your transition to ICD-10 because your clinical records will already reflect relevant documentation associated with the ICD-10 billing code.

Are you ready for the ICD-10-CM Change?  

Missed the webinar or want to review the materials again? Access a pre-recorded presentation or the webinar slides .  

ICD-10 Updates

• Diagnostic Billing Code Updates Effective October 1, 2016

ICD-10 Basics

• Knowledge Briefs: One-Page Single Topics
  • Use DSM-5 to find ICD-10 codes
  • Procedure Codes
  • ICD-CM Indicator/Qualifier Codes for Claim Submission
  • Three ICD-10 Claim Requirements for HIPAA Validation
  • Claim Resubmissions or Corrections
  • Provider Express Claim Submission
  • Neuropsychology: Special Topics
    • Medical Focus - high level considerations
    • Valid Codes - ICD-10 Specificity
  • ICD-10 Readiness Checklist
  • Expanded “You Asked, We Answered” Q&A from ICD-10-CM Transition webinars
  • Quick Reference: Claim and Authorization Highlights
  • Frequently Asked Questions (FAQ)
  • ICD-10 Claim Testing Information
  • ReviewOnline ICD-10 Information Information for facilities that use ReviewOnline for online authorization requests
  • Registering on Provider Express is quick and easy, and can help make your ICD-10 transition smoother
    

ICD-10 Claim Submission Information

• NUCC Crosswalk: 1500 Claim form mapped to the EDI 837 Health Care Claim
  Use this resource from NUCC.org to compare data elements between the 1500 Claim form and the EDI 837 Health Care Claim
• Provider Express Claim Entry Update: ICD-10 Indicator Field (guided tour for ICD-10 change)
  Note: Provider Express Claim Entry feature is available for submission of outpatient/professional service claims

          Note: For additional information on claims, see Knowledge Brief section above

Diagnosis and Billing: The ICD-10 and DSM-5 Connection

• DSM Includes the ICD Code for Billing
• Optum Pay™ (Electronic Payments & Statements - EPS) - shorten your revenue cycle by having payments deposited directly into your bank account

Optum transitioned to use of the DSM-5 on October 1, 2014 for most memberships.

DSM-5 Transition - 2014

• Autism Focus
• Basics and Reminders
• Claim Submission
• Quick Reference: Most Frequently Asked Questions
• ReviewOnline DSM-5 Highlights (for hospitals using ReviewOnline)
• ReviewOnline DSM-5 Overview (for hospitals using ReviewOnline)
• DSM-5 Implementation Notice