Frequently Asked Questions

It was announced on November 8, 2012 that the legacy software, InstaClaim, would be discontinued. Due to the new 1500 Claim Form, expanded offerings from clearinghouses and more solutions offered in EMRs, it made sense to discontinue the product, though it has served the market well for years. It is possible that some clearinghouses may accept electronic claims created by old versions of InstaClaim, but InstaCode Institute does not support this product and will not be making any changes to this discontinued software program.

Please note that we cannot help you with password resets or any other type of support related to the InstaClaim product.

To access the tools and full sized forms, you will need to be signed in to your InstaCode account and go here:

http://www.instacode.com/2014-BHB-forms

We do not officially recommend any single program as a replacement for InstaClaim. There are several good programs currently available in the market which could meet your needs. You could get a claim form filler or take this opportunity to expand to a practice management system.

Because everyone has their own preferences, we highly recommend that before making any software choice, take the trial version of that program out for a good spin. Ask questions of that particular vendor and others who have used the software. Check out their support options.

We do not sell or support any of the options below, but they do give you an idea of what is out there in the marketplace:

FormDocs - This is a form filler software. Your old InstaClaim data can be transferred into this software. Free trial download available.

http://www.paperclaims.com/

AltaPoint - This is a practice management software with EHR available. Under Customer Center/Downloads you can down load a FREE Demo

http://altapoint.com/pricing/

Note: Some clearinghouses and/or insurance companies offer their own software for free or at greatly discounted rates.

The Diagnostic and Statistical Manual for Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is generally accepted as the authoritative guide for the diagnosis of mental disorders. This FAQ article was created to address some commonly asked questions about DSM coding and clear up some common misconceptions.


Q: Do I use DSM-5 codes when submitting insurance claims?

A:  The American Psychiatric Association states that "DSM-5 and the ICD should be thought of as companion publications." DSM is not an official HIPAA code set - ICD-9-CM (ICD-10-CM as of October 1, 2015) is the official HIPAA approved diagnostic code set for billing. Currently, DSM code numbers are based on ICD code numbers. If you want to be paid, you need to bill from the official code set - ICD. See the questions below for more about DSM codes versus DSM criteria. They are two entirely separate things!

It is up to the provider to understand the specific requirements for each payer. Some may say that you may use DSM-5 codes because they are closely correlated to ICD-9/10. Others may require providers to use the most accurate ICD-9/10 code to describe the condition. Keep in mind that in order to avoid allegations of improper billing, providers MUST adhere to the requirements of the payer.

We stated that they are "closely correlated" because the problem that we have had in the past, and continue to have, is that ICD code descriptions and DSM criteria do not always match one another. For example, as the ICD code set is revised, sometimes a single code is expanded into several codes. The code listed in a DSM book no longer is the most accurate code according to HIPAA standards. Providers need to be aware of any changes to the official HIPAA code set to avoid billing and reimbursement problems.


Q: Can clinicians use DSM codes?

A: The Center for Medicare and Medicaid Services (CMS), answers this question in FAQ1817 which says:

The Introduction to the DSM-IV indicates that the DSM-IV is “fully compatible” with the ICD-9-CM. The reason for this compatibility is that each diagnosis listed in the DSM-IV is “crosswalkedto the appropriate ICD-9-CM code. The DSM-IV is not a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that 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.


Q: Can I still use DSM-IV diagnostic criteria, even though DSM-IV (DSM-5) has not been adopted as a HIPAA code set?

A: CMS, who oversees HIPAA has stated the following (emphasis added):

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.

Notice that this statement only refers to "criteria". Yes, use the criteria to reach a clinically appropriate diagnosis, but CMS and most payers require that the codes for billing must be ICD-9-CM codes up until October 1, 2015 and ICD-10-CM thereafter.