Translating DC: 03R into ICD-9-CM Codes - Florida’s Crosswalk

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Translating DC 03R into ICD-9-CM Codes
-Floridas Crosswalk

• Kathryn Shea, LCSW
• The Florida Center for Child and Family
  Development
• Sarasota, FL
• kathryn.shea_at_thefloridacenter.org

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Translating DC 03R to ICD-9Floridas experience

• Brief History of IMH/DC 0-3 in Florida
• September, 2000 Floridas Strategic Plan for
  Infant Mental Health finalized and published.
  This document laid the groundwork for services,
  training, research and policy changes.
• Task force worked on policy changes specific to
  Community Mental Health services for children
  ages birth through five and their families
• Policy approved and published by ACHA (Agency for
  Health Care Administration)-Floridas Medicaid
  agency in May, 2002

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Translating DC 03R to ICD-9Floridas experience

• New policy recommended the use of
• DC 0-3 for assessment, diagnostic, and
  treatment purposes, but required
• ICD-9-CM code for reimbursement purposes.
• December, 2001 in anticipation of new policy,
  Kathryn Shea developed a Crosswalk between the
  DC 0-3 and ICD-9 codes.
• March, 2001 Crosswalk accepted as a guideline
  by both the State Alcohol, Drug, and Mental
  Health Office and ACHA.
• May, 2006 Revised Crosswalk to correspond to new
  DC 0-3R and submitted to ACHA and SAMH for
  approval. Crosswalk approved June, 2006.

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Translating DC 03R to ICD-9Floridas experience

• The Florida Center was part of the Florida Infant
  Mental Health pilot project from 2000-2003 and
  had gained significant experience in
  assessment/diagnosis of children birth to age
  three and their families.
• Approval of the Crosswalk allowed our agency to
  continue services to these children/families, as
  well as over 550 additional children/families
  since end of pilot.

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Translating DC 03R to ICD-9Floridas experience

• Development of the Crosswalk
• Impetus Change in Medicaid Community Mental
  Health Policy to specifically address children
  ages birth through five and their families with
  mental health problems.
• Context Policy recommended use of DC 0-3 for
  assessment/diagnostic purposes, but still
  required use of ICD-9-CM for reimbursement
• The Bubble Bath Insight
• The Imperfect Crosswalk

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Translating DC 03R to ICD-9Floridas experience

• Why crosswalk to ICD-9-CM and not DSM-IV??
• Medicaid requires the ICD-9-CM code
• Easier for clinicians to crosswalk directly to
  one code
• Higher probability of reimbursement if codes are
  directly linked to required code
• ICD-9-CM has different/varied codes that may be
  more young child friendly

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Translating DC 03R to ICD-9Floridas experience

• Fall, 2005 - DC0-3R published and released
• Summary of changes
• No longer includes Gender Identity Disorder
• Removed reactive attachment from Reactive
  Attachment Deprivation/Maltreatment Disorder of
  Infancy
• Renamed Traumatic Stress Disorder to
  Posttraumatic Stress Disorder
• Regulatory Disorders have been renamed Regulation
  Disorders of Sensory Processing

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Translating DC 03R to ICD-9Floridas experience

• Summary of changes
• Includes specific Anxiety Disorder subtypes in
  Anxiety Disorders of Infancy and Early Childhood
• Depression of Infancy and Early Childhood
  category includes Major Depression and Depression
  NOS
• Descriptions of Sleep Behavior Disorders and
  Eating Behavior Disorders incorporate subtypes
• DC 0-3R recommends use of Multisystem
  Developmental Disorder be restricted to children
  less than 2 years of age

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Translating DC 03R to ICD-9Floridas experience

• A crosswalk through the DC 03R diagnosis
• DC 0-3R diagnosis ICD-9-CM code
• (refer to crosswalk handout)

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Translating DC 03R to ICD-9Floridas experience

• Floridas Limitations
• Cannot bill for V codes on Axis I
• Florida Medicaid does not pay for community
  mental health services for treatment of autism,
  pervasive developmental delay, non-emotional or
  non-behavioral based developmental disability, or
  mental retardation.

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Translating DC 03R to ICD-9Floridas experience

• Implementation of the Crosswalk
• Approval from SAMH/ACHA for use of the Crosswalk-
  Special Thanks to Sandra Adams, Sue Ross and
  Catherine Goldsmith
• Training on the Crosswalk, increased use by
  clinicians across the state, multiple settings
• The Florida Center uses primarily in child
  welfare mental health services and outpatient
  mental health services

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Translating DC 03R to ICD-9Floridas experience

• Training/Supervision Needs
• On-going in clinical group supervision
• Case studies/presentations in each group
  supervision
• Video taping of assessments/treatment sessions
• Peer review of assessments/treatment
• Linking with State/National IMH trainings

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Translating DC 03R to ICD-9Floridas experience

• Utilization within payors
• Medicaid has reimbursed for all assessments and
  treatment services billed for birth through three
  clients using DC 0-3 and R crosswalk.
• Private insurance has reimbursed for 80 of
  assessments/treatment services billed for birth
  through three clients.

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Translating DC 03R to ICD-9Floridas experience

• The diagnostic dilemma
• The challenge does not lie in the use of the
  crosswalk the challenge lies in the controversy
  of diagnosing very young children

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Translating DC 03R to ICD-9Floridas experience

• Evaluation of Crosswalk
• No formal evaluation or research done
• Is being used state wide for reimbursement
  purposes
• Mental Health services being provided that
  otherwise would not have been
• The Florida Center has provided
  assessment/treatment services to over 550
  children/families since DC 03 Crosswalk approved

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Translating DC 03R to ICD-9Floridas experience

• Lessons Learned
• Bubble Baths are really good things
• Having good relationships with folks at state
  levels that can make things happen is a really
  good thing
• Supervision and Training needs to be a high
  priority, yet fiscally difficult to do

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Translating DC 03R to ICD-9Floridas experience

• Promising Practices/Next Steps
• Diagnostic Decision Tree looks very promising
• Recommend Zero to Three produce video tapes of
  assessment/clinical discussion/
  diagnosis/crosswalk code would be very helpful
  (similar to ICDL Training Videotapes on the DIR
  Model)
• National data base on birth to three Axis I II
  Diagnosis w/ MH diagnosis in primary caregiver

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Medicaid Documentation

• Medicaid Made Easy Simplify all you can
• Create check lists for each file of what/when due
• Create forms that makes it easier for the
  workers, but gives Medicaid the information it
  needs
• Conduct trainings frequently (quarterly minimum).
  The more the workers hear the same information,
  the more it sinks in
• Conduct peer supervision of charts to ensure
  quality and accountability

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Medicaid Documentation

• Its not about quantity of writing.
• Its about quality of writing and incorporating
  all aspects of service provision