Does anyone know if ICD-9 and DSM-IV is the same thing?
I am familiar with DSM-IV,,,but just heard about ICD-9
From what I read about the description of ICD on the wrights law web site, it seems like the same thing? Am I wrong? If I am , what's the difference?
Thanks!!
kelly
I use to be a claims adjuster for auto claims. ICD-9 codes are the codes medical providers use to submit to insurance companies for payment. There are different ICD-9 for different levels of evaluations and procedures. Often times we would get chiropractors submitting billings with ICD-9 codes that went along with comprehensive exams for cancer done by onocologists. It's an insurance term, not really a medical term.
ahh..ok,,I wasn't sure ..so it seems that they use ICD codes for insurance coding reasons more than a medical diagnosis. Thanks for the clarity!!
kelly
DSM-IV is the official guide written by the American Psychiatric Association for use by Psychiatrists in determining whether someone has a psychiatric disorder that has to be diagnosed clinically (through expert observation as opposed to some sort of physical medical test). It is the official manual in America and some other countries but some countries use their own, different criteria. ASD is under the section called Pervasive Developmental Disorders. There are 5 possible medical diagnoses in this area: Autism, Pervasive Developmental Disorder Not Otherwise Specified, Asperger Syndrome, Rett Syndrome and Childhood Disintegrative Disorder. Every few years, the APA updates the DSM. As a result, some older people are diagnosed using old terminology. A good example of this is that nowadays there is something called bipolar disorder. Before the current DSM, it was called manic depression. Same thing, different name. PDD-NOS used to be called Atypical Autism. But the 5 highlighted terms are the only official medical diagnoses used today. In schools, all 5 are included under the ONE term used by the schools -- Autism.Don't worry if your ICD-9 code is different from your DMS-IV dx.
The official diagnosis via DSM-IV should be accurate. The ICD-9 code on the invoice for any services you receive from your child should be the one that your insurance company is most likely to pay on.
Many private therapists get a little creative with the codes (for your benefit), particularly if your child has multiple things going on. There are certain ICD-9 codes to always avoid, such as 315.3, 315.31, 315.39 and 315.9 as these are for developmental speech and language disorders. Insurance companies will never pay on anything remotely associated with the word "developmental" as it implies that the child will simply grow out of it eventually, with or without therapy. We've been using 784.69 Apraxia of speech and insurance has been paying up. (Occasionally I get a denial and I just keep submitting until it eventually lands on the desk of someone who isn't paying attention or doesn't care and it gets paid after 2 - 3 tries.) Yet another game we have to play - as if we all don't have enough to do...
[QUOTE=kristys](Yet another game we have to play - as if we all don't have enough to do...
[/QUOTE]
I know! They sure don't make it easy!
Kelly