Differences Based on the Order of Listing of Diagnostic Codes
In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), all of the below listed codes are for mental disorders due to a general medical condition. In the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM), these codes are considered secondary to the general medical condition and thus the general medical condition must always be listed first. This is the one difference that might technically lead to a “coding violation” in that rules governing the order in which diagnoses are listed is violated. In DSM-IV-TR, use of any of these codes requires the DSM-IV-TR user to list the causative general medical condition on Axis III. However, in ICD-9-CM, the general medical condition must always precede the psychiatric condition. If the diagnoses are listed in the order that they are written using the conventions of the multiaxial evaluation, the general medical condition, which in ICD-9-CM is supposed to ALWAYS precede the 293 or 294 codes, would instead follow it, which is a clear violation of ICD-9-CM rules. Thus, at a minimum, users must be cautioned to switch the order of presentation of these codes.
This applies to the following DSM-IV-TR codes:
293.0
293.81
293.82
293.83
293.84
293.89
294.0
294.10
294.11