DSM-5: Potential Impact of Key Changes on Pharmacy Practice

Tammie Lee Demler, BS, PharmD, MBA, BCPP


US Pharmacist 

In This Article

Insurance Implications

Insurance companies are currently revising their reporting and billing procedures to address the changes detailed in DSM-5. Some companies may require older DSM-IV-TR diagnoses and codes for a while, as guidelines are still being developed by the Centers for Medicaid and Medicare Services (CMS) and private insurers. The CMS has weighed in on these diagnostic inconsistencies and billing concerns, noting that DSM-IV and DSM-5 have been crosswalked to reflect compatibility with the old International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and the new ICD-10-CM diagnosis codes. The ICD-10-CM codes will be the only accepted HIPAA-adopted standard and will be required for diagnosis reporting for dates of service beginning October 1, 2014. The CMS encourages providers to continue to use DSM-IV/DSM-5 criteria for diagnostic decision making, quality management, and communication with patients. Eventually, the APA will establish a date by which DSM-IV will no longer be acceptable for use by mental health providers. In the meantime, the transition to DSM-5 will include review and revisions of practitioner board-certification examinations and standards to measure quality of medical-record documentation.[2]