Technical Report 31: Updating the Psychiatric Case Mix System (PsyCMS) Mental Health and Substance Use Grouper for ICD-10-CM
Todd H. Wagner,1 Elizabeth Gehlert,1 Amy Rosen,2 Marcia Valenstein3
1Health Economics Resource Center, VA Palo Alto, Menlo Park, CA.
2Boston VA Health Care System, Boston MA.
3VA Ann Arbor Health Care System, Ann Arbor, MI.
Suggested CitationWagner TH, Gehlert E, Rosen A, Valenstein M. Updating the Psychiatric Case Mix System (PsyCMS) Mental Health and Substance Use Grouper for ICD-10-CM. Technical Report 31. Health Economics Resource Center, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs. November 2016.
All tables for the report are saved in an Excel file. Download the tables here.
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1. Overview
Risk-adjustment tools are invaluable in health services research because they allow us to control for clinical heterogeneity in the population that would otherwise bias our analyses of costs, quality and outcomes. In 2014, the United States Department of Veterans Affairs (VA) Office of Productivity, Efficiency and Staffing and the VA Health Economics Resource Center (HERC) jointly developed a new risk-adjustment system for VA cost data. The new system, Nosos, which means ‘chronic condition’ in Greek, is based on the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) version 21 (V21) risk adjustment system. However, to make the V21 system more robust and suited to the VA population, Nosos includes additional variables important in classifying the VA population: race, marital status, non-VA health insurance status, Veteran’s priority level status, VA registry status, VA drug class and 46 psychiatric case mix system (PsyCMS) condition categories, developed by Rosen and colleagues (Montez-Rath et al. 2006; Sloan et al. 2006).
PsyCMS was designed using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes from all Veterans who used VA healthcare services during the federal fiscal year 1999 (FY99). On October 1, 2015, all United States healthcare systems were required to begin using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). This report describes the methods HERC used to update PsyCMS with ICD-10-CM codes. Section 2 presents the methods used to update the PsyCMS coding scheme and Section 3 presents the final coding scheme.
November 2016 update: For PsyCMS category 26 (Tobacco use) we have added 1 additional ICD-10-CM code, Z72.0.
May 2019 update: We have updated PsyCMS with changes for the ICD-10-CM F codes in FY2017 and FY2018. For a log of changes, see Table 5.
2. Methods
We had two independent reviewers assess each new ICD-10-CM mental, behavioral and neurodevelopmental disorder code (F01-F99) and assign it to one of the original 46 PsyCMS condition categories. Each reviewer completed this assignment twice. Each reviewer reconciled any disagreements between their first and second coding assignments; then the reviewers jointly reconciled coding discrepancies between the sets of coding assignments. When differences existed, we asked a VA psychiatrist with research experience to review the assignments and make the final determination.
We then met with staff from the VA Office of Mental Health Operations’ Program Evaluation and Resource Center (PERC), which has their own mental health and substance use grouper software. We were interested in aligning the two systems to reduce any potential confusion that would be caused by having similar but different grouper software. Ultimately, we decided that the existing 46 categories were not detailed enough to cover the drastic increase in the number of ICD-10-CM codes related to mental health and substance use, and additional categories needed to be created.
Thus, to accommodate the increased specificity of ICD-10-CM mental health and substance abuse codes, we first removed the ICD-9-CM category ‘Drug use remission’ and created the following more specific ICD-10-CM PsyCMS remission categories:
- Opioid use remission
- Amphetamine use remission
- Cannabis use remission
- Other specified drug use remission
- Unspecified drug use remission
- Nicotine use remission
- Major depressive disorder (MDD) in remission
We also created the following new ICD-10-CM PsyCMS substance use and condition categories:
- Amphetamine dependence
- Amphetamine abuse
- Cannabis dependence
- Cannabis abuse
- Major depressive disorder (MDD) with psychosis
- Phobias
- Attention deficit disorder (ADD)
- Intellectual disabilities
3. Results
The final ICD-10-CM PsyCMS includes 62 mental health and substance use disorder categories (an increase of 16 categories). We have included several tables. Table 1 is the PsyCMS summary table by category, which is organized by each of the 62 PsyCMS categories and which specific ICD-10-CM codes are in the category. Table 2 is the PsyCMS by ICD-10-CM code table, which lists each ICD-10 mental health and substance use codes, the short description and the grouper. Table 3 is the PsyCMS category changes from ICD-9-CM to ICD-10-CM, which summarizes which categories were kept, removed or added in the move to ICD-10-CM. Table 4 is the hierarchy of the PsyCMS ICD-10-CM codes, which shows how the PsyCMS ICD-10-CM condition categories were coded to create hierarchies.
4. Ongoing Work
We are currently reviewing the performance of the ICD-10-CM PsyCMS mental health and substance use disorder categories using FY16 data.
References
Montez-Rath M, Christiansen CL, Ettner SL, et al. Performance of statistical models to predict mental health and substance abuse cost. BMC medical research methodology. 2006;6:53.
Sloan KL, Montez-Rath ME, Spiro A, et al. Development and validation of a psychiatric case-mix system. Med Care. Jun 2006;44(6):568-580.
AcknowledgementsWe would like to thank the Office of Mental Health Operations Program Evaluation and Resource Center (PERC) for providing insight and collaboration in coding, especially Jodie Trafton, PhD and Aaron Dalton, MA, MSW. We would also like to acknowledge financial support from the Operation Value Initiative funded by the VA Office of Analytics and Business Intelligence/Office of Informatics and Analytics and VA Operational Analytics and Reporting.
Last Updated Date: March 21, 2022