(Autism, Asperger’s, and Rett’s syndrome is this kind of disorder.)
DSM 5 AND ICD-10 · task force –best global measure of disability. How DSM 5 changes things ......
Transcript of DSM 5 AND ICD-10 · task force –best global measure of disability. How DSM 5 changes things ......
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
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:
EMR screen shots with permission and courtesy of Valant Medical Solutions - www.Valant.com
NCBH Natcon 2015 - Booth #631http://valant.com/ncbh-meeting-request/
Important Stuff