Diagnostic and Statistical Manual of Mental Disorders
The International Classification of Diseases (ICD) and the Current
Procedural Terminology address two major portions of the healthcare
industry; however, there is one area (mental health) that is not sufficiently
addressed by these systems. To provide a mechanism for reporting
conditions found in mental healthcare facilities, the American Psychiatric
Association (APA) developed the Diagnostic and Statistical Manual of
Mental Disorders (DSM). The codes in this manual are used by mental
health professionals to assign diagnoses for patients being treated for
substance abuse and mental disorders. The codes in this manual are also
used in research, administration, and educational programs. These codes are
covered by the Health Insurance Portability and Accountability Act (HIPAA).
The DSM codes are not completely compatible with the ICD-9-CM codes. It
is very important for staff members who code for services performed in the
mental health facilities, behavioral health units, or other types of
rehabilitation units that use the DSM codes, to understand both the DSM
and ICD-9-CM codes. There are other types of coding systems used in
facilities for patients with intellectual and developmental disabilities, but
these types are not covered in this course.
There are five axes used in the process of diagnosing. These axes cover
clinical disorders, personality disorders and intellectual disabilities, general
medical conditions, psychosocial and environmental problems, and global
assessment of functioning. By using these axes, clinicians are able to
establish a systematic evaluation of a patient, helping diagnosis the
conditions of the patient (Sayles, 2013). Changes to improve the processes
of classifications in mental health diagnosis are available in the most current
printing of this manual, the DSM-V.
The Balanced Budget Refinement Act of 1999 mandated per diem
payments for inpatient psychiatric services furnished in hospitals. Inpatient
psychiatric facilities are reimbursed in much the same way as other
inpatient facilities using the per diem payment, based on the diagnosis-
related group (DRG), wage-adjusted rates, and facility-level adjusters. The
per diem rates became effective in January, 2005, and the rates are updated
each year. The codes found in the DSM do not affect the payment rates;
these codes provide a mechanism for communicating and recording
diagnostic information and are used in areas of research and statistics
(Green, 2014).
Just as acute care facilities can be accredited by organizations such as the
Joint Commission, psychiatric and rehabilitative facilities can request
accreditation through the Commission on Accreditation of Rehabilitation
Facilities (CARF). The facility will complete the application requesting
accreditation and, once accredited, will undergo a site visit every three
years. The CARF accreditation process is highly tailored to patient care
services. There are specific requirements for the facilities, but the
requirements can be adjusted based on patient care and community
requirements. The survey process will consist of opening and closing
conferences, a document review, and interviews with staff and patients.
Any deficiencies found are summarized in a report prepared by the
surveyors (Shaw & Elliott, 2012).
References
Green, M. A. (2014). 3-2-1 Code it! (4th ed.). Clifton Park, NY: Delmar.
Sayles, N. B. (2013). Health information management technology: An applied
approach (4th ed.). Chicago, IL: American Health Information Management
Association.
Shaw, P. L., & Elliott, C. M. (2012). Quality and performance improvement in
healthcare (5th ed.). Chicago, IL: American Health Information Management
Association.
