APA petitions CMS for additions to ICD-10-CM: Deadline for public comment and objections November 15

Post #276 Shortlink: http://wp.me/pKrrB-3tq

Information in this report relates to American Psychiatric Association (APA) proposals, submitted via the September ICD-9-CM/PCS Coordination and Maintenance Committee Meeting, for the inclusion of a number of additions to the forthcoming US specific ICD-10-CM.

ICD-9-CM is the official system of assigning codes to medical diagnoses in the United States. Next year, ICD-9-CM will be replaced by ICD-10-CM, scheduled for implementation on October 1, 2014.

The DSM is widely used by CMS contractors, federal and state agencies and medical insurers to indicate eligibility for provision of services.

Since the official codes required in the United States for records and reimbursement purposes are ICD-CM codes, DSM diagnoses are cross-walked to the closest approximation of ICD-CM codes to classify diagnoses for insurance claims, research, data capture and other public health purposes.

APA petitions ICD-9-CM Coordination and Maintenance Committee:

The ICD-9-CM and ICD-10-CM coding systems are subject to annual revisions by NCHS and CMS via public review meetings held twice a year (in March and September), followed by brief public comment periods.

October 1, 2011 saw the last major update of ICD-10-CM/PCS until October 1, 2015. Between October 1, 2011 and October 1, 2015 revisions to ICD-10-CM/PCS will be for new diseases/new technology procedures, and any minor revisions to correct reported errors in these classifications. Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2015.

The ICD-9-CM Coordination and Maintenance Committee will continue to meet twice a year during this partial code freeze. At these meetings, the public will be asked to comment on whether or not requests for new diagnosis or procedure codes should be created based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10-CM on and after October 1, 2015 once the partial code freeze has ended.

At last month’s Coordination and Maintenance Committee meeting, APA presented seven diagnoses that are new to DSM-5, along with proposals for new codes for addition to the ICD-10-CM [1]. APA states that the new codes, if approved [by NCHS/CMS], would probably not be added to ICD-10-CM until 2015.

Yesterday, APA published an article in Psychiatric News (the PR organ of the APA), listing the additions and changes proposed by APA via the September meeting (about two thirds into the article):

ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013 DOI: 10.1176/appi.pn.2013.10b30

The following disorders were proposed by APA for inclusion in ICD-10-CM (Pages 32-44, Diagnosis Agenda).

Dr Regier’s presentation starts on Day Two of the meeting, video Part 4, 13:50 mins in from start and concludes after PMDD.

Binge eating disorder (BED);
Disruptive mood dysregulation disorder (DMDD);
Social (pragmatic) communication disorder;
Hoarding disorder;
Excoriation (skin picking) disorder;
Premenstrual dysphoric disorder (PMDD)

Additionally, the APA has petitioned for revisions to the ICD-10-CM listing for gender dysphoria in adolescents and adults, which is not a new disorder. Dr Regier’s presentation concluded with recommendations for PMDD.

Edit: On Page 45 and 46 of the Agenda, under Additional Tabular List Inclusion Terms for ICD-10-CM a number of other changes to specific Chapter 5 F codes are proposed, including the addition to the ICD-10-CM Chapter 5 codes of the new DSM disorders:

Somatic symptom disorder (proposed as Inclusion term to F45.1 Undifferentiated somatoform disorder)

Illness anxiety disorder (proposed as Inclusion term to F45.21 Hypochondriasis)

None of these 16 proposed additional inclusion terms to the ICD-10-CM Mental and behavioural disorders (Chapter 5) F codes, as listed on Pages 45-46, were presented or discussed by Dr Regier on behalf of the APA but presented briefly and en masse by Donna Pickett.

I have pasted screenshots from the Agenda at the end of this report [Ref 5].

Ms Pickett introduced this section of the Agenda on Day Two, video Part 4, 1 hour 22 mins in from start.

Diagnosis Agenda Item Page 45-46: “Additional Tabular List Inclusion Terms for ICD-10-CM”

Co-Chair Donna Pickett: “…And just to complete the package, there are other Tabular List proposals that appear on Page 45 and 46 that we would also invite your comments on. And again, as with some of the terminology changes that Dr Regier has described the intent here is to make sure that if those terms are being used, that they do have a home somewhere within ICD-10-CM to facilitate people looking these up. So we invite comments. We’re showing the Tabular List proposed changes. However, there obviously would be associated Alphabetic Index changes with that which we didn’t show [in the Agenda] just to keep the package a little bit smaller.”

With no discussion taking place on rationales for individual proposals and no comments or questions being received from the floor or by phone link, Ms Pickett moved swiftly forward to introduce the next Agenda item.

Since these proposals are unattributed in the Agenda, the provenance of these additional 16 code change requests is unclear (that is, whether the requestors are CMS/CDC, Collaborating Centre for the WHO-FIC in North America, WHO ICD-10 Update Committee, WHO ICD-11 Revision, APA or other petitioners).

If the addition of new DSM-5 disorders Somatic symptom disorder and Illness anxiety disorder had been proposed by the APA, it is unclear why these were not included within Dr Regier’s presentation for discussion.

Blink and you might have missed the proposal to incorporate Somatic symptom disorder and Illness anxiety disorder into ICD-10-CM – so little time and attention being devoted to this section of the Agenda.

Note that Hypochondriasis (Illness anxiety disorder) is proposed to be included in the ICD-11 Beta draft under dual parents Obsessive-compulsive and related disorders and Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere.

Full proposals from APA and other petitioners can be read in the ICD-9-CM/PCS Coordination and Maintenance Committee Meeting Sept 18–19, 2013: Proposals document at:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

(Diagnosis Agenda) Proposals document [PDF – 342 KB]:

http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

A Summary report of the Procedure part of the September 18–19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting is not yet available. This is expected to be posted on the CMS webpage in October, at:

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html

and also on the CDC’s website page for the meetings.

Other Meeting materials (Agenda, Proposals and four YouTubes of the two-day September meeting proceedings) are now available from this page [3]:

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2013-09-18-MeetingMaterials.html

There is an ICD-9-CM and ICD-10-CM/PCS revisions Timeline set out on pages 3 thru 7 of the Proposals PDF [2].

Submitting public comment:

The deadline for receipt of public and professional stakeholder comment on any of the proposed ICD-10-CM/PCS code revisions discussed at the September 18-19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting is November 15, 2013.

Comments should be sent to the following NCHS email addresses:

Procedure comments by email to Pat Brooks, CMS: patricia.brooks2@cms.hss.gov

Diagnosis comments by email to Donna Pickett, CDC: nchsicd9CM@cdc.gov

Full contact details for submission of comments/objections to NCHS/CMS are on page 8 of the Proposals PDF. The meeting co-chairs state that electronic submissions are greatly preferred over snail mail in order to ensure timely receipt.

Responders are asked to consider the following:

Whether you agree with a proposal, disagree (and why), or have an alternative proposal to suggest.

But also to comment on the timing of those proposals that are being requested for approval for October 2014.

Does a proposal for a new or changed Index entry and Tabular List entry meet the criteria for implementation in Oct 2014 during a partial code freeze or should consideration for inclusion be deferred to Oct 2015 implementation? And separately, comment on the creation of a specific new code for the condition effective from October 1, 2015.

I shall post reminders before the November 15, 2013 deadline date and also a copy of the September meeting Summary document, once this is available. (Posting of the Summary document may be delayed due to the government shut-down and you may prefer to review the YouTubes of the meeting proceedings rather than wait for the Summary document to appear.)

+++

References for key documents and screenshots:

1. Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013:
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1757346

2. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting September 18-19, 2013:
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

September meeting Proposals document [PDF – 342 KB]:
http://www.cdc.gov/nchs/data/icd9/icd9cm_proposals_91819.pdf

3. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting Sept 18-19, 2013 meeting materials and four YouTubes of proceedings:
http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2013-09-18-MeetingMaterials.html

4. YouTube Videos from September 18, 2013 Meeting Day One

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 1
http://www.youtube.com/watch?v=Ut3DmV88Dmc

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 2
http://www.youtube.com/watch?v=CAE190sM5AQ

ICD-9-CM Coordination and Maintenance Committee Meeting (Afternoon Session) Part 3
http://www.youtube.com/watch?v=QQOFadq2x6U

September 19, 2013 Meeting Day Two

ICD-9-CM Coordination and Maintenance Committee Meeting Part 4
http://www.youtube.com/watch?v=G-pYdKyr_NE

5. Pages 45-46, Diagnosis Agenda:

ICD10CM 1

ICD10CM 2

ICD10CM 3

DSM-5 released: professional and campaigning reaction: Round up #7

Post #262 Shortlink: http://wp.me/pKrrB-3cF

DSM-5 released: professional and campaigning reaction: Round up #7

A considerable amount of media coverage and commentary on DSM-5 has been published since posting Round up #6, on May 24. Occupied with other matters, I shall likely not catch-up. The world will continue to turn.

Here, though, are some recent commentaries from psychiatry and psychology professionals; a report from Prof Sir Simon Wessely on last week’s Institute of Psychiatry’s two day DSM-5 Conference; below that, new Online Assessment Measures documents from the APA’s DSM-5 Resource pages, including Somatic Symptom assessment instruments for 6-17 year olds, and a clarification from CMS on HIPAA and the status of the DSM-5 code sets.

Via Patrick Landman

Pédopsychiatre, Psychiatre, Président d’Initiative Pour une Clinique du Sujet Stop-Dsm, Psychanalyste Membre d’Espace Analytiquea

A statement written and signed by prominent French psychiatrists in response to recent comments by APA President-Elect, Jeffrey Lieberman, was issued, yesterday:

Full text on the STOP-DSM campaign website:

To oppose the DSM-5 is not to oppose psychiatry

Recently, some of the DSM-5 supporters have been trying to portray the opposition against the fifth edition of this manual of the American Psychiatric Association as an opposition to psychiatry and a form of antipsychiatry. This political argument aims to discredit the movement and to subsume it in its entirety, including its numerous variations, under a single label, one that can easily be identified and connected with a certain history, the sixties. Such specious rhetoric allows its authors not to have to respond to serious and well-documented arguments of the DSM-5 critics. In reality, its many opponents from Europe, Australia, South America and even the United States include a great number of psychiatrists, clinical psychologists, social workers and other mental health practitioners… Read on


Report on the website of South London and Maudsely NHS Foundation Trust from Prof Sir Simon Wessely on the Institute of Psychiatry’s recent DSM-5 Conference.

Prof Wessely is Head of the Department of Psychological Medicine and Vice Dean, Institute of Psychiatry, King’s College London. 

DSM-5 at the IoP

Monday June 10, 2013

The latest and fifth version of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), invariably known as the DSM, was published on 18 May 2013. To mark the occasion, we hosted an international conference at the Institute of Psychiatry from 3-4 June. This was the first such meeting since the launch and the first platform for Professor David Kupfer, Chair of Psychiatry at the Western Psychiatric Institute in Pittsburgh, but more importantly for us, the man who has directed the compilation and development of DSM-5, and who is justly regarded as its architect…

…I used the somatoform disorders as an example of where “DSM feared to tread”. The latest attempt to come up with something that is both empirically rigorous but also suitable for real world use in this particular area represents a small step forward, at least in simplifying an area of previous mind numbing complexity, but I suggested, was unlikely to represent real progress. This is because the DSM (and for that matter the ICD) are both diagnostic systems that are written by psychiatrists but which in this area need to be used by physicians, who ignore them, and concern patients who don’t like them, often fiercely so… Full Text


Essay by Sarah Kamens MA on the Dx Summit platform

DSM-5′s Somatic Symptom Disorder: From Medical Enigma to Psychiatric Sphinx

Sarah Kamens is a Ph.D. candidate in clinical psychology at Fordham University and in media & communications at the European Graduate School (EGS). Her work focuses on diagnostic discourse and sociopolitics in the psy disciplines.


Spiked Review of Books

‘This manual is, frankly, a disaster for children’

Christopher Lane talks to spiked about the new edition of the bible of psychiatry – ‘a legal document facilitating the medication of millions’.

by Helene Guldberg


http://www.psychiatry.org/dsm5

DSM-5 Online Assessment Measures

APA is inviting clinicians and researchers to provide feedback on the instruments’ usefulness in characterizing patient status and improving patient care. There are a large number of documents that can be downloaded from the link above, including:

For Adults

LEVEL 2–Somatic Symptom–Adult (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Parents of Children Ages 6–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 6-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Children Ages 11–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 11-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

Clinician-Rated

Clinician-Rated Severity of Somatic Symptom Disorder


Finally, a note on the FAQ pages of the CMS.gov website which clarifies the non official status of DSM-5 code sets:

Frequently Asked Questions

(FAQ1817)

[Q] In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, the DSM-5 was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?

[A] Yes. The Introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are “compatible” with the ICD-9-CM diagnosis codes. The updated DSM-5 codes are crosswalked to both ICD-9-CM and ICD-10-CM. As of October 1, 2014, the ICD-10-CM code set is the HIPAA adopted standard and required for reporting diagnosis for dates of service on and after October 1, 2014.

Neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2014, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.

Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, http://www.dsm5.org

(FAQ1817)

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