Translating DC: 03R into ICD-9-CM Codes - Florida’s Crosswalk Kathryn Shea, LCSW The Florida Center for Child and Family Development Sarasota, FL

Translating DC: 03R to ICD-9 Florida’s experience Brief History of IMH/DC: 0-3 in Florida September, 2000 Florida’s 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)-Florida’s Medicaid agency in May, 2002

Translating DC: 03R to ICD-9 Florida’s 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.

Translating DC: 03R to ICD-9 Florida’s experience The Florida Center was part of the Florida Infant Mental Health pilot project from 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.

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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”

Translating DC: 03R to ICD-9 Florida’s experience Fall, DC:0-3R 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

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s experience A “crosswalk” through the DC: 03R diagnosis DC: 0-3R diagnosisICD-9-CM code (refer to crosswalk handout)

Translating DC: 03R to ICD-9 Florida’s experience Florida’s 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.

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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.

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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

Translating DC: 03R to ICD-9 Florida’s 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

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

Medicaid Documentation It’s not about quantity of writing…. It’s about quality of writing and incorporating all aspects of service provision