Oklahoma’s Crosswalk for DC: 0-3R and ICD-9-CM

Oklahoma’s Behavioral Health Collaborative made up of all the child serving state agencies, providers, and consumers/consumer advocates (OHCA, ODMHSAS, OKDHS, OJA, OSDOE, OCCY, OSDOH, Federation of Families, Transformation Innovation Center, and OKIMHA) have been focused on strengthening our State’s BH system for children 0-3. Many efforts are under way to broaden workforce competencies through a clinical endorsement process, developing avenues for screening and assessment for early detection/prevention, and changing current systems structures and policies to support BH services for children 0-3 and families. One systems change needed would be the inclusion of a developmentally appropriate diagnostic tool for our State’s children ages 0-3.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised 2005 (DC:0-3 R) was the strongest diagnostic tool available but unfortunately is not currently considered a HIPAA compliant code set usable for Medicaid SoonerCare billing purposes. The collaborative made the decision to develop a crosswalk tool, as many other states have done, for their providers to use when filing claims. Utilizing some other state’s tools like Indiana and Arizona, Oklahoma developed their own crosswalk tool.

Note: (Collaborative members are committed to coordinating trainings in order to broaden knowledge of (1) early screening/assessment tools and appropriate diagnosing for children 0-3; (2) the DC:0-3 R; and (3) the appropriate usage of the Oklahoma DC:0-3 R/ICD-9-CM crosswalk when billing our state’s payment systems.)

The DC: 0-3R/ICD-9-CM crosswalk is a tool to assist the clinician in assigning the correct diagnostic code required for reimbursement when working with children under the age of three. If a DSM-IV-TR diagnosis best describes the primary presenting difficulty, then it would be coded in Axis I and the corresponding ICD-9-CM code utilized. For example, if the diagnosis is Pica, Rumination Disorder, or another diagnosis not included in the DC: 0-3R, the clinician would list the appropriate DSM-IV-TR diagnosis and utilize the appropriate ICD-9-CM code.

Disclaimer: End dated diagnosis codes are not valid for current use. It is recommended that the current ICD-9-CM book be used in conjunction with this list to validate fourth and fifth digit requirements.

State of Oklahoma DC:0-3 R, DSM-IV-TR, and ICD-9-CM Crosswalk
Axis I: Clinical Disorders
DC: 0-3 R		DSM-IV-TR			ICD-9-CM
100: Posttraumatic Stress Disorder
100	Post Traumatic Stress Disorder	309.81	Posttraumatic Stress Disorder		308.0 308.2 308.3 309.81	Predominant disturbance of emotions Anxiety, emotional crisis, or panic state as acute reaction to exceptional (gross) stress Predominant psychomotor disturbance Agitation states or stupor as acute reaction to exceptional (gross) stress Other acute reactions to stress Acute situational disturbance Acute stress disorder Posttraumatic stress disorder Chronic posttraumatic stress disorder Posttraumatic stress disorder NOS
150	Deprivation/Maltreatment Disorder	313.89	Reactive Attachment Disorder		*995.50 *995.51 *995.52 *995.53 *995.54 *995.59	Child abuse, unspecified Child/emotional/psychological abuse Child neglect (nutritional) Child sexual abuse Child physical abuse Battered baby or child syndrome Other child abuse and neglect Multiple forms of abuse
200: Disorders of Affect
210	Prolonged Bereavement/Grief Reaction	V62.80 296.2		Bereavement Major Depressive Disorder, Single Episode	309.0 309.1	Adjustment disorder with depressed mood Grief reaction Prolonged depressive reaction
220: Anxiety Disorders of Infancy and Early Childhood
221	Separation Anxiety Disorder	309.21		Separation Anxiety Disorder	309.21	Separation anxiety disorder
222	Specific Phobia	300.29		Specific Phobia	300.20 300.29	Phobia, unspecified Anxiety-hysteria NOS Phobia NOS Other isolated or specific phobias Acrophobia, animal phobias, claustrophobia, or fear of crowds
223	Social Anxiety Disorder (Social Phobia)	300.23		Social phobia	300.23	Social phobia Fear of eating in public, speaking in public, washing in public
224	Generalized Anxiety Disorder	300.02		Generalized anxiety disorder	300.02	Generalized anxiety disorder
225	Anxiety Disorder NOS	300.00		Anxiety Disorder, NOS	300.00	Anxiety state, unspecified
230: Depression of Infancy and Early Childhood
231	Type I: Major Depression	296.2x 296.3x		Major depressive disorder, single episode Fifth digit must be inserted: 0 unspecified 1 mild 2 moderate 3 severe, w/o psychotic behavior 4 severe, specified as with psychotic disorder 5 partial/unspec remission 6 in full remission Major Depress, Recurrent	296.2x 296.3x 309.0 309.1	Major depressive disorder, single episode Fifth digit must be inserted: 0 unspecified 1 mild 2 moderate 3 severe, without mention of psychotic behavior 4 severe, specified as with psychotic disorder 5 in partial or unspecified remission 6 in full remission Major Depression, Recurrent Adjustment Disorder w/Depressed Mood Prolonged Depressive Reaction
232	Type II: Depressive Disorder NOS	311		Depressive Disorder, NOS	311 313.1	Depressive disorder, not elsewhere classified Depressive disorder NOS, depressive state NOS, depression NOS Misery and Unhappiness Disorder
240	Mixed Disorder of Emotional Expressiveness	296.90		Mood Disorder, NOS	296.90 313.9	Other and unspecified mood disorder Unspecified emotional disturbance of childhood or Adolescence Mental disorder of infancy, childhood, or adolescence NOS
300	Adjustment Disorder	309.0 309.24 309.28 309.3 309.4 309.82 309.83 309.89 309.9		Adj dis w/ depress mood Grief reaction Adjustment dis w/ anxiety Adj dis w/ mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct Conduct dist or destructiveness as adjustment reaction Adj dis w/ mixed disturb of emots and conduct Adjustment reaction with physical symptoms Adjustment reaction with withdrawal Elective mutism as adj reaction Hospitalism (in children) NOS Adjustment Reaction, Other Unspecified adj reaction Adapt react, NOS Adj reaction, NOS	309.0 309.24 309.28 309.3 309.4 309.82 309.83 309.89 309.9	Adjustment disorder with depressed mood Grief reaction Adjustment disorder with anxiety Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with disturbance of conduct Conduct disturbance or destructiveness as adjustment reaction Adjustment disorder with mixed disturbance of emotions and conduct Adjustment reaction with physical symptoms Adjustment reaction with withdrawal Elective mutism as adjustment reaction Hospitalism (in children) NOS Adjustment Reaction, Other Unspecified adjustment reaction Adaptation reaction NOS Adjustment reaction NOS
400: Regulation Disorders of Sensory Processing
410: Hypersensitive
411	Type A: Fearful/Cautious	300.00 300.02 309.0 309.24 309.28 309.9		Anxiety Disorder, NOS Gen Anxiety Disorder Adj Dis w/Dep Mood Adj Dis w/Anxiety Adj Dis w/Mixed Anx & Depressed Mood Unspec Adj Disorder	300.00 300.02 309.0 309.24 309.28 309.9 313.0 315.4	AnxietyState, unspecified Generalized Anxiety Disorder Adj Dis w/Depressed Mood Adj Dis w/Anxiety Adj Dis w/Mixed Anxiety & Depress Mood Unspecified Adjustment Reaction Overanxious disorder Anxiety and fearfulness or overanxious disorder of childhood and adolescence Developmental Coordination Disorder Clumsiness Syndrome Dyspraxia Syndrome Specific Motor Development Dis
412	Type B: Negative Defiant	309.0 309.24 309.28 309.3 309.4 309.9 312.9		Adj Dis w/Dep Mood Adj Dis w/Anxiety Adj Dis w/Mixed Anx & Depressed Mood Adj Dis w/Dist of Conduct Adj Dis w/Mixed Dist of Emotions & Conduct Unspecified Adj Disorder Disruptive BH Dis, NOS	309.0 309.24 309.28 309.3 309.4 309.9 312.9 313.81 315.4	Adjustment Disorder w/Depressed Mood Adjustment Disorder w/Anxiety Adj Disorder w/Mixed Anxiety & Dep Mood Adjustment Disorder w/Dist of Conduct Adjustment Disorder w/Mixed Disturbance of Emotions & Conduct Unspecified Adjustment Reaction Disruptive Behavior Disorder, NOS Oppositional Defiant Disorder Developmental Coordination Disorder Clumsiness Syndrome Dyspraxia Syndrome Specific Motor Development Dis
420	Hyposensitive/Under-responsive	309.9		Unspecified Adj Disorder	309.9 313.2 313.21 313.22	Unspecified Adjustment Reaction Sensitivity, Shyness, & Social Withdrawal Shyness disorder of childhood Sensitivity reaction of childhood or adolescence Introverted disorder of childhood Social withdrawal or withdrawal reaction of childhood or adolescence
430	Sensory Stimulation-Seeking/Impulsive	309.3 309.4 312.3 312.9		Adj Dis w/Dist of Conduct Adj Dis w/Mixed Dist of Emotions and Conduct Impulse Control Disorder Disr BH Disorder, NOS	309.3 309.4 312.3x 312.9 314.01 314.1 314.9	Adjustment Disorder w/Dist of Conduct Adjustment Disorder w/Mixed Disturbance of Emotions and Conduct Impulse Control Disorder Disruptive Behavior Disorder, NOS Attention Deficit Disorder w/Hyperactivity Combined type Overactivity NOS Predominantly hyperactive/impulsive type Simple disturbance of attention withoveractivity Hyperkinesis with developmental delay Developmental disorder of hyperkinesis Use additional code to identify any associated neurological disorder Unspecified hyperkinetic syndrome Hyperkinetic reaction of childhood or adolescence NOS Hyperkinetic syndrome NOS
500 Sleep Onset Behavior Disorders
510 520	Sleep-Onset Disorder (Protodyssomnia) Night-Waking Disorder (Protodyssomnia)	307.45 307.46 307.47		Circadian Rhythm Sleep Disorder Sleep Terror Disorder Nightmare Disorder Parasomnia, NOS	307.40 307.41 307.42 307.45 307.46	Nonorganic sleep disorder, unspecified Transient disorder of initiating or maintaining sleep Adjustment insomnia Hyposomnia, insomnia, or sleeplessness associated with intermittent emotional reactions or conflicts Persistent disorder of initiating or maintaining sleep Hyposomnia, insomnia, or sleeplessness associated with: anxiety, conditioned arousal, depression (major)(minor), psychosis Idiopathic insomnia Paradoxical insomnia Primary insomnia Psychophisioogical insomnia Circadian rhythm sleep disorder of nonorganic origin Sleep arousal disorder Night terror disorder, night terrors, sleep terror disorder, sleepwalking, somnambulism
600 Feeding Behavior Disorders
601 602 603 604	Feeding Disorder of State Regulation Feeding Disorder of Caregiver-Infant Reciprocity Infantile Anorexia Sensory Food Aversions	307.59		Eating Disorder of Infancy, NOS	307.50 307.59 *783.3 *779.3	Eating Disorder, unspecified Eating disorder, NOS Other feeding disorder of infancy or early childhood of nonorganic origin infantile feeding disturbances or loss of appetite of nonorganic origin Feeding difficulties and mismanagement Regurgitation, slow feeding, vomiting in newborn
605 606	Feeding Disorder Associated with Concurrent Medical Condition Feeding Disorder Associated with Insults to the Gastrointestinal Tract	309.0 309.24 309.28 309.3 309.4 309.9		Adj Dis w/Dep Mood Adj Dis w/Anxiety Adj Dis w/Mixed Anx & Depressed Mood Adj Dis w/Dist of Conduct Adj Dis w/Mixed Dist of Emotions & Conduct Unspecified Adj Disorder	309.0 309.24 309.28 309.3 309.4 309.9	Adjustment Disorder w/Depressed Mood Adjustment Disorder w/Anxiety Adj Disorder w/Mixed Anxiety & Dep Mood Adjustment Disorder w/Dist of Conduct Adjustment Disorder w/Mixed Disturbance of Emotions & Conduct Unspecified Adjustment Reaction
700: Disorders of Relating and Communicating
710	Multisystem Developmental Disorder (MSDD) for children under the age of two years; Pervasive Developmental Disorders can be utilized for children over the age of two if identified	299 299.9 313.9		Autistic Disorder Pervasive Developmental Disorder, NOS Disorder of Infancy, Childhood, or Adolescence, NOS	299.0x 299.9x	Autistic disorder childhood autism infantile psychosis Kanner’s syndrome Fifth digit must be inserted: 0 current or active state 1 residual state Unspecified pervasive developmental disorder Child psychosis NOS Schizophrenia, childhood type, NOS Schizophrenia syndrome of childhood NOS Fifth digit must be inserted: 0 current or active state 1 residual state
Axis II: Relationship Classification *Parent-Infant Rx Global Assessment Scale (PIR-GAS) *Relationship Problems Checklist * found on page 43 in DC:0-3 R
N/A	Overinvolved Underinvolved Anxious/Tense Angry/Hostile	V61.20		Parent-Child Rx Problem	V61.20 313.3	Parent-Child Problems Relationship Problems
	Verbally Abusive Physically Abusive Sexually Abusive	V61.21		Neglect Physical Abuse of Child Sexual Abuse of Child	V61.21 V61.22	Counseling of Victim of Child Abuse Counseling for Perpetrator of Parental Child Abuse
Axis III: Medical and Developmental Disorders and Conditions
Axis IV: Psychosocial Stressors *Psychosocial and Environmental Stressor Checklist * found on page 56 in DC:0-3 R
Axis V: Emotional and Environmental Stressors Checklist *Capacities for Emotional and Social Functioning Rating Scale *Infant Toddler Social Emotional Assessment *Child Behavior Checklist (1.5 – 5) *Ages and Stages Questionnaires: Social Emotional * suggested tools

Axis I differences:

Arizona uses Oppositional Defiant Disorder for 412 Type B: Negative Defiant, but Indiana feels that a child this age does not have the cognitive capacity needed to act purposefully or intentionally to anger another person. Plus noted that difficult behavior can occur when young children are overwhelmed.