Behavioral Health Providers and ICD-10

On October 1, 2015, all health care providers are required to switch from ICD-9 to ICD-10 codes. Behavioral health providers use DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the 2013 update to the American Psychiatric Association's classification and diagnostic tool, but that does not exclude them from the transition to ICD-10.

DSM-5 is a clinical tool used by licensed professionals in order to formulate a diagnosis for treatment; whereas, ICD codes are required for reimbursement of claims through NC Tracks and the LME-MCOs. Behavioral health providers will continue to use DMS-5 for the diagnosis on a prior approval (PA) request, but they will have to transition from ICD-9 to ICD-10 for claim submission. Claims with dates of service on or after October 1, 2015, will deny unless submitted with an ICD-10 code.