When the DSM-5 comes out, are you automatically given a new diagnosis?

February 2, 2013 11:39 AM

The DSM-5 is coming. I have a diagnosis that is being revamped in the new edition, the name is totally different. Does my doctor do a new evaluation and converts it over, or just converts it himself by clicking some things in a computer, or does the wording/paperwork/dx code stay the same? Also, does everything have to be reevaluated since there are minor changes to many things?

I don't think it's too hard to figure out which I am specifically talking about for myself from my previous questions, but if you need to know because you have some expert knowledge on the subject pertaining to the change in that area, feel free to memail me. I am also curious in a more general sense, so if you generally know what's going to happen, say, from an insurance perspective, I would also like to know what you have to say about it.

posted by lettuchi to health & fitness (5 answers total)

Generally it doesn't much matter from a medical standpoint. Anybody who is pretending the DSM is some kind of algorithmic cookbook is way, way off. As for insurance most psychiatrists have long since been managing conditions under different diagnosis than the probable "real" condition for a variety of reasons, whether legal or purely for reimbursement.

When pressed most ethical psychiatrists I worked with would at most venture to something like "mood, not otherwise specified" for billing codes in order to avoid any potential legal or coverage problems unless they absolutely had to slap on a diagnosis, months after treatment began.
posted by hobo gitano de queretaro at 12:16 PM on February 2 [1 favorite]

If you have insurance coverage, your practitioner may have to change the diagnostic code for submitting bills.
posted by theora55 at 12:40 PM on February 2

This should be something you can ask your doctor about. At my last appointment, my doctor mentioned the effect that the new coding would have on her. She apparently received different instructions from each insurance carrier, with some wanting to move everything over to new codes, some wanting to keep the old codes, and some wanting to adopt only a subset of the new codes.
posted by duien at 1:19 PM on February 2

For the purposes of the diagnosis code used for billing purposes, it won't be material until many years after the DSM-5 is released, although there's a different change in diagnostic coding in the pipeline soon that will affect the diagnosis you're billed with.

The diagnosis codes used for medical billing are from the ICD, the International Classification of Diseases and Related Health Problems. In the US, the edition of these codes used for billing is transitioning next year from ICD-9-CM to ICD-10-CM (this is the transition that duien's doctor was telling her about). DSM-5 diagnoses won't be incorporated into the ICD until ICD-11 is released, and it'll still be years after that before ICD-11 codes are fully adopted for billing.

Here is what seems to be a decent overview of what the ICD-10 transition will mean for psychologists that also discusses the possible timeline for DSM-5 and ICD-11 implementation. I don't know much personally about how the transition has affected behavioral health billing in particular, but I can tell you that it's incurred immense amounts of effort and expense across all of medical billing, and that the US is one of the vary last countries to adopt ICD-10.
posted by strangely stunted trees at 1:36 PM on February 2 [2 favorites]

Hi, I'm in the same situation re. having a DSM-IV diagnosis in a category that is being revamped for the DSM-V. Specifically, the dx I've had for years is Asperger's, but apparently that designation is going to be subsumed in an "Autistic Spectrum Disorders" entry. Since I don't currently receive any sort of state assistance, etc., my guess is there will be no detectable changes to my daily life once the new guidelines are put into practice. I have yet to lose any sleep over it, and frankly I'm looking forward to not having to say something that sounds like "ass burger" when the matter of my dx comes up. :P

I also don't expect that everyone diagnosed under the old criteria will suddenly have to go through a re-evaluation process in order to avoid "diagnostic limbo"...the human resources to do that simply don't exist in the numbers that'd be needed for everyone dxed under the "old" guide to do everything all over again. It would be mass chaos and people would end up on waiting lists for years.

All that aside, a friend who is a practicing psychologist tells me that there will definitely likely be changes to insurance billing codes, etc., and that this is probably going to mean paperwork for clinicians, if nothing else. But as others have noted, that isn't going to happen all at once, and it's probably best to inquire with your specific doctor, especially if you are receiving services contingent upon your particular current dx.
posted by aecorwin at 10:38 AM on February 3