and the grass grows by itself…
We think about it more now than we used to, but it still hasn’t thoroughly sunk in – the USA is just a country in a world of many countries. And from a medical perspective, the real overarching organization is the WHO established by the United Nations. One of its functions is to maintain the The International Classification of Diseases [ICD]. The United States is treaty bound to use the ICD to report diseases to its public health database – vital for health policy decisions around the world. For obvious reasons, the ICD is also the standard used for other reporting – Medicare, Medicaid, third party carriers, CDC, etc.
|The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] is the official system used in the United States to classify and assign codes to health conditions and related information. The use of standardized codes improves consistency among physicians in recording patient symptoms and diagnoses.|
|The ICD-9-CM contains a list of alphanumeric codes which correspond to diagnoses and procedures recorded in conjunction with hospital care in the United States. For example, a patient with acute appendicitis will be assigned a code of 540. This code may be entered onto a patient’s electronic medical record and used for diagnostic, billing and reporting purposes. Related information also classified and codified in the system includes symptoms, patient complaints, causes of injury, and mental disorders.|
|The United States Department of Health & Human Services and the Centers for Medicare and Medicaid Services created ICD-9-CM as an extension of the Ninth Revision, International Classification of Diseases [ICD-9], which the World Health Organization [WHO] established to track mortality statistics across the world.|
Of course, we have to be a bit special, so the official disease classification is the ICD-9-CM [The International Classification of Diseases, Ninth Revision, Clinical Modification] a subset for America. While there’s currently an ICD-10, the US version [ICD-10-CM] won’t be in use until 2015 if even then. Because the ICD-11 is in preparation, due out in 2015-2016, it’s possible we’ll just skip ahead to it. The only thing that matters to we mortals is that the ICD-10 and coming ICD-11 use a different coding scheme than the ICD-9 and ICD-9-CM, so all the codes are different even if the diagnoses have been kept the same. That’s the major reason that we haven’t made the changeover. Every computer system will need redoing, a massive and expensive task. These weighty matters are beyond my further elucidating powers [or patience], but I’m pretty sure I’ve got that part right.
The Diagnostic and Statistical Manual [DSM] is a creation of the American Psychiatric Association. It came to life in 1952 as a simple code-book with terse definitions [DSM] revised in 1968 [DSM-II]. The creation of the DSM-III in 1980 was something very different. It was written as a textbook with defined diagnostic criteria for each disorder. It was still a code-book and the codes were from the ICD, but it was treated as much more. It was adopted everywhere, or so it seemed. But what was official were the codes. The definitions were simply what the APA Task Force said they were.
Which brings us to now, with the DSM-IV  as the widely used standard in mental health. The American Psychiatric Association is suggesting that we buy their DSM-5, due out in May this year. Well, it’s going to have the same diagnostic codes as the DSM-IV – the ICD-9-CM codes. And when they finally change-over to the ICD-10-CM or the ICD-11, the DSM-5 will have to change too. So the DSM-5 is the official code-book for the APA. But that has about the same meaning as Papa John’s Pizza is the official pizza of the super-bowl [which is no meaning at all]. Eating Dominos is allowed. The reason to buy the DSM-5 is for the words in between the codes, not for anything that has to do with your practice or official reporting to third party carriers [or anywhere else]. It’s the textbook part that’s for sale, not the codes. You’ve already got them in your DSM-IV or on the Internet, and when they change ICDs in a few years, they’ll be widely available [a “how-to”…]: