Saving Normal

Mental health and what is normal.

Does DSM 5 Have a Captive Audience?

No. DSM 5 codes are not needed for insurance reimbursement

DSM 5 sells at a price gouging $200/copy. The American Psychiatric Associations has assumed that it has a fully captive audience of people who will feel compelled to buy DSM 5 for coding and reimbursement purposes- even if they don't like its contents or cost.

To reinforce this rather cynical selling point, APA recently posted a misleading statement implying that DSM 5 has some sort of official status. The message is that clinicians and institutions must buy DSM 5 if they hope to be reimbursed by insurance.

http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Insur...

This is simply not the case. The only official codes are the ones provided by the International Classification of Disease (ICD)- in the US, that now means ICD-9-CM. The editors of DSM's simply pick the ICD codes they feel most resemble the DSM categories. Their choices are based solely on their own opinions, not through any officially sanctioned mechanism and they carry no special weight. There is nothing sacred about the DSM 5 choices- I know because I am the one made the final choices for DSM IV.

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So there is no reason for potential buyers of DSM 5 to feel the slightest bit captive or intimidated by APA. The DSM 5 codes will be essentially the same as the old ICD-9-CM codes that are already contained in DSM IV.

People who are concerned about the risky suggestions in DSM 5, or are angry about its startling price tag, can simply stick to coding using their old DSM IV. Or they can buy one of many alternative guides to psychiatric diagnosis that will be available (COI disclosure- I have written one of these myself). Or they can download the ICD-9-CM codes completely for free at http://www.cdc.gov/nchs/icd/icd9cm.htm

My advice to clinicians, insurance companies, educators, and policy makers is simply to ignore DSM 5. Its suggestions are reckless, unsupported by science, and likely to result in a great deal of loose, inaccurate diagnosis and unnecessary, harmful, and costly treatment.

Diagnostic inflation is already running rampant at what seems like an accelerating pace. Last week the CDC reported that rates of autism had jumped rapidly once again to 1/50- forty times greater than 20 years ago and up from 1/80 last year and 1/110 two years ago.

The CDC also found that a ridiculous 20% of high school boys now have a diagnosis of ADD and that a troubling 10% are on medication. This makes no sense.

DSM 5 threatens to turn the current diagnostic inflation into future hyper-inflation.

My advice - the best protection against wild over-diagnosis is to ignore DSM 5. It is not official. It is not well done. It is not safe. Don't buy it. Don't use it. Don't teach it.

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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