Getting patients sober is a challenging job. Billing for that job is sometimes even harder. Sometimes it feels like the system is designed to be confusing. There are so many codes and one simple error can completely throw off an entire revenue cycle. Understanding how the different types of codes interact with one another is critical to billing success. 

Today, let’s take a deep dive into ICD-10 codes for addiction treatment billing and learn more about how to leverage these powerful alphanumeric values to get the reimbursements your organization deserves.

What are ICD-10 Codes?

ICD stands for the International Statistical Classification of Diseases and Related Health Problems. It is a tool developed by the World Health Organization (WHO) to standardize health care codes across international boundaries and facilitate world-wide sharing of health information for study and research. All member states of WHO have adopted ICD codes as their billing language, including the United States. HIPAA requires that healthcare providers use ICD codes for any electronic billing, reimbursement, or reporting activities. 

The ICD is currently in its 10th version—hence the designation “ICD-10.” WHO’s World Health Assembly (WHA) is working on launching an 11th version, creatively titled ICD-11. ICD-11 is scheduled to take effect in January 2022. Yes, the codes may change again, but for now we’ll just look at ICD-10 codes. 

Whenever you are billing for a service that is connected to a diagnosis—which should be always, if you’re looking to get reimbursed by your patient’s insurance company—then you’re going to be using an ICD-10 code. 

The Difference Between DSM, ICD, and CPT Codes 

As an addiction treatment provider, your work is littered with acronyms. Insurance billing for addiction treatment is no exception. There are three main acronyms to know when it comes to insurance billing codes: DSM, ICD, and CPT. Each of these codes plays a part in forming a whole picture of the patient’s diagnosis and treatment.

DSM Codes—Where it All Begins

The process of diagnosing a patient begins with locating their condition in the Diagnostic Statistical Manual (DSM). Each DSM diagnosis has its own code but those codes are largely irrelevant in terms of modern billing, as HIPAA now requires that you use the corresponding ICD-10 code when you’re submitting claims. When the industry-wide switch from DSM codes to ICD-10 codes took place in 2015, the American Psychological Association (APA) developed “crosswalks” or “bridges” between DSM and ICD-10 codes to help American providers learn to translate DSM codes into ICD-10 codes. Although DSM codes aren’t used in billing today, the DSM is still the tool of choice for determining a patient's diagnosis, which is ultimately the first step in developing a billing code.

ICD Codes—Describing Diagnosis

Once you’ve selected a diagnosis in the DSM, it’s time to find the corresponding ICD-10 code to describe the patient's diagnosis. There are quite a few different codes for the various types of substance use disorder you’ll see in your patients. Having a good list of codes like this one handy can help in identifying the right code. 

Working with a good billing service that specializes in behavioral health like BehaveHealth can help you optimize your documentation and make sure that your staff is always choosing the best ICD codes for each situation. When each insurance provider handles each code differently, it can help to have an experienced team on your side to double-check your work. 

CPT Codes—Relaying Treatment

The final piece in the coding puzzle is a Current Procedural Terminology (or CPT) code. CPT codes describe the treatment you’ve provided to the patient based on their diagnosis. The CPT code is always informed by the ICD code you choose. The CPT code should always represent a treatment that your patient's insurance company will agree is warranted and “necessary” given the patient’s diagnosis. Knowing what treatments are allowable for each insurance company is critical when you’re choosing a CPT code. It’s so important that you—or your billing service—complete a thorough verification of benefits and a rock-solid utilization review before your staff starts choosing CPT codes. 

The Importance of ICD-10 Coding for Addiction Treatment Billing 

Choosing the wrong ICD-10 code sets up your entire claim for failure. If there were just one ICD-10 code for substance use disorder, then it would be easy to always choose the correct code, but it’s just not that simple. To make matters even more complicated, each insurance company will have different rules and expectations based on different ICD-10 codes. Learning what to expect from each insurance company when you bill for each code can feel like a process of trial and error, especially when you are first starting out. 

We Know Addiction Treatment Billing

At BehaveHealth, our team of behavioral health insurance billing specialists work with ICD and CPT codes for addiction treatment providers day in and day out. We know how the insurance system works and we stay up to date on all of the unwritten rules of the game. Our team is dedicated to keeping your revenue cycles running strong and passionate about getting your organization its fair share of insurance reimbursements. Our all-in-one software system combines the best of addiction treatment EHR technology and integrated billing available on the market.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.