Since DSM-IV-TR has not been officially adopted as a “HIPAA Code Set,” can I still use the DSM-IV-TR criteria for making psychiatric diagnosis?
Yes. The US Government has officially sanctioned the continued use of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria. Two entries on the Frequently Asked Questions section of the Center for Medicare Services web site address this issue:
In response to the question “Can clinicians continue current practice and use the DSM-IV diagnostic criteria?” the site states “clinicians may continue to base their diagnostic decisions on the DSM-IV criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.” (Click here for the complete entry on the CMS web site)
In response to the question “Can mental health practitioners, agencies, institutions and others still use DSM-IV diagnostic criteria, even though DSM-IV has not been adopted as a HIPAA code set?,” the site notes that “the basic purpose for adopting code sets under HIPAA is to standardize the ‘data elements' used in the electronic processing of certain administrative and financial health care transactions. While the patient's diagnosis is a data element used in such transactions, the criteria considered by the clinician in reaching a diagnosis are not. Practitioners are free to use the DSM-IV diagnostic criteria—or any other diagnostic guidelines—without any HIPAA-related concerns.” (Click here for the complete entry on the CMS web site)