How To: View, Add, and Delete Diagnosis Codes

Diagnoses and their corresponding codes identify disorders, symptoms, and other reasons for client visits. The International Statistical Classification of Diseases and Related Health Problems (ICD), maintained by the World Health Organization, is the international standard for diagnostic coding. For mental and behavioral health, the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, standardizes diagnostic criteria for the classification of mental disorders. DSM diagnoses and the related ICD codes are required by most payers in order to bill insurance.

TherapyNotes includes the latest DSM-5 diagnoses and their corresponding ICD-10 diagnosis codes (including updates as they are released) by default, helping you stay up-to-date with diagnostic standards. The diagnoses available to your clinicians can be customized to fit the needs of your organization. For example, you may wish to include relevant physical health diagnoses (such as hypothyroidism or smoking status) in your documentation and on claims. Additionally, providers who render non-behavioral health services (such as PT/OT/SLPs and others) will need to add the necessary diagnoses to their accounts. You may also decide to remove available codes - this is an easy way to ensure that non-billable codes are not used.

Role Required: Clinical Administrator

To view your existing diagnosis codes:

  • Click the User Icon > Settings > Diagnosis Codes
  • From the Show dropdown, select to view DSM-5 DiagnosesDSM-IV Diagnoses, or Custom Diagnosis Codes

To add a custom diagnosis code:

  • Click the User Icon > Settings > Diagnosis Codes
  • Click the Add Custom Diagnosis Code button

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  • Enter your Diagnosis Code, Description, and Specifiers
Quick Tip: Specifiers are extensions of a diagnosis that allow for further categorization of an otherwise homogeneous diagnosis. They clarify the severity, symptom type, or special features of the disorder or illness.
  • Click the Add Diagnosis Code button

To delete a diagnosis code:

  • Click the User Icon > Settings > Diagnosis Codes
  • From the Show dropdown, select to view DSM-5 DiagnosesDSM-IV Diagnoses, or Custom Diagnosis Codes
  • Click Delete next to the diagnosis code you wish to remove
  • A dialog titled Delete Diagnosis Code will appear. Click the Delete Diagnosis Code button.

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