Understanding how changes in the DSM-IV and ICD-9-CM affect your life

Jan 24, 2012
Tagged with:

Understanding how the changes in the DMS-IV and ICD-9-CM affect your life can help you manage your own healthcare and education/ work situation.

Unfortunately, the healthcare and disability systems can be difficult to understand, since so many times the information comes in “codes” like “DSM” and “ICD”. This short blog will explain what the terms mean and how they are used- so that you can see the ways that these tools create the standardized actions required of doctors by their licensing boards. This whole thing, of course, affects you by impacting your diagnosis, coverage for your healthcare and education, and your standing as a person with a disability.

The DSM-IV (as explained in an earlier blog on this site) stands for the words “Diagnostic and Statistical Manual- fourth edition”. It is the newest in a series of diagnostic manuals that psychologists and psychiatrists must use (according to their licensing boards) to identify whether or not a patient fits the criterion (list of symptoms) that are known by a diagnostic term (like Autism, ADHD, Depression or Bipolar Disorder).

As you can see, since the doctors must all follow the standardized guidelines for their field, the first step in a disability diagnosis occurs when the doctor gives the patient a diagnosis from the DSM-IV.

The second step in the process is that the diagnosis a person is given is used by the other tool- the ICD-9-CM – to access payments from healthcare insurance to the doctor or the medical care facility.

“ICD-9-CM” stands for the “International Classification of Diseases- version nine” and is the standard code used by healthcare insurance companies to identify the illness, diagnosis, medical condition and treatment that the doctor ordered.

The DSM does not remain constant, and is regularly under development- with new manuals coming out after a lengthy revision process. The next DSM in the series, the DSM-V, will be published in 2013. While the specific criterion (or cluster of symptoms that the doctor has to notice to give the diagnosis) may change; the process of using the DSM to identify the diagnosis and then the ICD to code the information for healthcare insurance payments stays pretty much the same. The ICD is also updated from time to time, and changes in the ICD will be next be published in 2014.

Changes in either the DSM or the ICD codes impact people with disabilities by affecting their coverage for SSI, and healthcare payments. Changes also affect people who are awaiting a disability diagnosis since changes in the codes may make people either more eligible or less eligible for a specific diagnosis.

A number of changes are currently being considered for both the DSM and the ICD. For example, the DSM changes include adding “toddler tantrums” and “grief after the loss of a spouse” to diagnostic criterion. The ICD has already decided to add “wandering” to the defining criterion for Autism. Doctors began to use that new criterion (symptom) in October 2011.

As always, some people and constituencies are pleased by a change, while others revile the change. In this case, some disability professionals do not like the addition of “wandering” because they don’t believe that there is adequate research to suggest that wandering is more than a behavior. Some advocates appreciate the addition of “wandering” because their home lives have been disrupted by having to nail shut windows, install internal door alarms and exhaustively provide 24/7/365 observation of their child who wanders away from home without understanding the consequences.

Changes such as the proposed shift to consider tantrums by 2 year olds as mental illness cause concern among both professionals and advocates who believe that diagnoses lead to medical management in many cases; while the long-term impact of some medications on young children have not been well studied.

The change to identify the grief felt by a widow or widower as a mental illness also concerns the public who wonder if there will be anyone left in America without a mental illness diagnosis once the final changes are made.

You can learn more about these proposed changes – and join the public commentary on them- by Googling “ICD-9-CM update” or “DSM-IV update”.

Updates are often published in the professional journal “Journal of Mental Health” that may be available in a university library near you or online.

Author: Tanya