.png)
DSM-5 vs ICD-10-CM: What Every Therapist Needs to Understand
- Vina Goodman
- 6 days ago
- 5 min read
Updated: 2 days ago
Diagnostic codes are an important part of every therapist’s work. However, when it comes to DSM-5 and ICD-10-CM, confusion often emerges. Although both systems are widely used, they serve different purposes and are managed by different organizations. Understanding the difference between DSM-5 and ICD-10 is not just about theory—it has a real impact on documentation, billing accuracy, compliance, and the quality of client care.
Let’s break it down clearly so you can work smarter and avoid costly errors.
What Are DSM-5 Codes?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is developed and published by the American Psychiatric Association (APA). It provides standardized criteria for diagnosing mental and behavioral disorders. This includes symptom thresholds, duration requirements, and diagnostic specifiers.
Think of the DSM-5 as the clinical manual therapists use to identify what’s happening with a patient from a diagnostic and psychological lens. It’s critical for determining diagnoses during assessments, treatment planning, and communication among clinical professionals. On the other hand, DSM-5 codes aren’t typically used for billing.
What Is ICD-10-CM?
The ICD-10-CM—or International Classification of Diseases, 10th Revision, Clinical Modification—is a diagnostic coding system managed by the World Health Organization (WHO) and adapted in the U.S. by the CDC.
ICD's main role
To classify diseases, symptoms, injuries, and causes of death across all areas of medicine.
ICD-10-CM provides the official diagnostic codes for insurance claims. If you’re billing Medicaid, Medicare, or private insurance, you're using ICD codes, not DSM codes, even if the diagnosis was based on DSM criteria.
That’s where many therapists run into issues: using DSM-5 to diagnose, but ICD-10-CM to bill. Read more for a deeper understanding of how ICD-10 codes directly affect reimbursement and compliance.
Major Differences Between DSM-5 and ICD-10-CM
Understanding the DSM vs. ICD difference is critical for any therapist juggling clinical accuracy with billing compliance.
If you’re looking for a difference between DSM-5 and ICD-10 PDF, it would closely reflect the breakdown above. But the key takeaway? DSM is for diagnosis, and ICD is for billing.
When and How to Use Each Code Set
Let’s say you’re a therapist diagnosing a child with ADHD. You’ll start with DSM-5, identifying if the symptoms meet the specific criteria. Once diagnosed, you’ll assign the appropriate ICD-10-CM code (e.g., F90.0 for ADHD, predominantly inattentive type) for documentation and billing.
Therapists often ask, “Do I need to include both codes in my documentation?”
Real-Time Example: Mapping DSM-5 to ICD-10-CM in Daily ABA Practice
Let’s say Emma, a licensed therapist at a behavioral clinic, completes an intake evaluation for a 10-year-old client presenting with persistent sadness, fatigue, and poor concentration. After a full assessment, Emma clinically diagnoses the client with Major Depressive Disorder, recurrent, moderate, based on DSM-5 criteria. This diagnosis is documented in the client's chart and treatment plan.
When Emma's documentation is sent to the billing team, they use the mapped ICD-10-CM code F33.1 to submit the insurance claim. The ICD code ensures that the payer recognizes and processes the claim correctly for reimbursement.
DSM-5 (Clinical use): Major Depressive Disorder, recurrent, moderate
ICD-10-CM (Billing use): F33.1
By documenting with DSM-5 and billing with the mapped ICD-10-CM, the clinic stays compliant, ensures timely payment, and aligns with payer requirements. If you often map DSM-5 to ICD-10-CM, you’ll find our ABA Code Conversion Table useful—it’s a quick reference for therapists translating behavioral health diagnoses into billable codes.
In short, “DSM-5 vs ICD-10-CM isn't about choosing one over the other; it's about using both appropriately”.
Bridging DSM-5 and ICD-10-CM in Daily Practice
Here’s where practical strategies come into play. Therapists need systems that ensure accuracy and prevent claim denials.
Train Clinical and Billing Teams Together
Your billing staff doesn’t need to be experts in psychopathology, but they do need to understand how DSM-5 diagnoses translate to ICD-10-CM codes. And your clinical team needs to know which ICD-10-CM codes align with payer policies.
Use EMR Systems That Auto-Crosswalk
Modern Electronic Medical Records (EMR) or Revenue Cycle Management (RCM) systems can crosswalk DSM-5 codes to ICD-10-CM automatically. EMR systems help to reduce manual errors and speed up documentation.
Maintain Updated Crosswalks
The APA and CMS both publish mapping resources. Keep these handy so your team can reference the DSM and ICD differences during coding and reviews.
Align Documentation with Payer Policies
Each insurer may have specific requirements. Some expect ICD-10-CM codes in certain formats or attached to certain CPT codes. Be proactive in aligning internal documentation with what your payers expect.
Practical Implications for Therapists
Choosing Between DSM-5 and ICD-10-CM
In day-to-day practice, therapists often use both systems—but when it comes to insurance billing, ICD-10-CM takes priority. For clinical charting, include both DSM-5 and ICD-10-CM when possible. This dual coding approach supports clear diagnosis and smooth reimbursement.
Legal and Ethical Considerations
Using an ICD-10-CM code that doesn’t match the DSM-5 diagnosis isn’t just a technical error—it can have serious legal consequences. If the billing code doesn’t align with the clinical record, it could lead to denied claims, audits, or accusations of fraud. Keeping documentation accurate and ethical protects both your license and your client’s care.
Real-World Example: When It Backfires
A therapist diagnosed a teenager with Generalized Anxiety Disorder (DSM-5) but submitted F32.0—the ICD-10-CM code for Depression—on the insurance claim. It seemed harmless at the time, but during an audit, the mismatch was flagged.
The insurance company pulled back the payment, labeled it as potential fraud, and launched a broader review. What started as a single coding shortcut turned into weeks of billing delays, legal stress, and loss of trust with the payer.
Documentation Requirements
Your documentation should reflect the diagnosis as per DSM-5, followed by the ICD-10-CM code used for billing. For example:
The client meets DSM-5 criteria for Generalized Anxiety Disorder. Corresponding ICD-10-CM code: F41.1.
This creates a defensible, traceable record that’s compliant with both clinical and billing standards.
Consequences of Inaccuracies
Rejected or denied claims
Compliance violations
Delays in client care
Audit triggers from payers
This is why the difference between ICD and DSM isn’t just academic. It’s practical, legal, and financial.
Staying Informed
Subscribe to APA updates, attend CEUs on diagnostic coding, and work closely with your billing team. If your EMR or EHR system doesn’t prompt for updates, consider switching to one that does.
FAQ
1. What is the difference between DSM-5 and ICD-10-CM?
DSM-5 is used for diagnosing and classifying mental disorders; ICD-10-CM is used primarily for billing and reimbursement across all medical specialties. They serve complementary purposes.
2. Do ICD-10 codes need to be supported by medical documentation?
Yes. ICD-10-CM codes must be supported by clear, accurate, and defensible documentation that reflects the diagnosis as outlined by DSM-5 criteria.
3. What is the main purpose of the ICD-10 coding system in ABA?
ICD-10 codes in ABA therapy exist to standardize diagnoses for billing. They ensure claims meet insurance requirements and trigger reimbursement—regardless of the clinical system used to assess.
Conclusion
Understanding the difference between DSM-5 and ICD-10-CM is essential. DSM-5 supports accurate diagnosis, while ICD-10 ensures billing and claims go through. Therapists need both to keep things running right.
Use an EMR that links DSM-5 to the right ICD-10 codes, train your team well, and stay on top of updates. That’s how you stay compliant, avoid billing errors, and keep your practice steady.