by Edward Zuckerman, PhD

The APA Crosswalk is available for download at the Practice Organization's website but it has these limitations:

1. Only psychologists who are APA members and have paid the extra charge for the Practice Organization have access to the website.

2. It is 16 pages long when printed out and so not too easy to use.

3. It’s “conversion” is not very equal. There are maybe a hundred ICD-9 diagnoses shown in this table without equivalent DSM codes. There are ICD diagnoses with no DSM equivalent which are simply ignored but I presume can be used. For example 293.84, 294.11. And, in fact there are hundreds more codes in the official versions of each.

4. All entries in this table lack proper capitalization. DSM capitalizes each major word (and so requires knowledge of English). ICD, being an international product, capitalizes only the first letter of the first word of a diagnosis.

5. Some parallels do not seem equivalent to me and seem forced only because the numbers coincide. For example 294.8 is “amnestic disorder NOS” (sic) in the DSM but “other specified organic brain syndromes (chronic)” in the ICD column. The current ICD language is actually “Other persistent mental disorders due to conditions classified elsewhere”. The amnestic part is dealt with in 294.0.

Similarly, just below, the DSM entry for 294.9 is “cognitive disorder NOS” (sic) and the ICD entry is “unspecified organic brain syndrome (chronic)” but the actual ICD code includes “Cognitive disorder NOS” which you would not find looking only at the crosswalk. This kind of paralleling makes the ICD look less adequate and more frustrating for clinicians.

6. When ICD contains a diagnosis which is considered to be “under study” by DSM, such as 301.12 there is no DSM entry in the crosswalk.

7. The crosswalk simply does not contain the changes made to ICD-9 which became required starting October 2004. For example, the codes for 290.4x are for "vascular" dementia in DSM and were adopted into ICD-9 to replace “arteriosclerotic” dementia. Similarly, the old ICD term “organic” has been replaced by “Psychotic disorder” or “Mood disorder” but the older term is still shown on the APAPO's crosswalk. Also, “syndrome” has been replaced by “disorder” in ICD but is not so shown. I don’t know how many other codes where the two do not match are similarly out of date.

8. All the 291 and 292 codes are missing from both sides. 291 is Alcohol-induced mental disorders and 292. is Drug-induced mental disorders. I use these codes a lot, don't you?

9. Some entries are quite incomplete. For example 293.0 is “delirium due to … [general medical condition]” in the DSM side and its parallel is “acute delirium.” However, the accurate ICD entry is “Delirium due to conditions classified elsewhere.” Also, this rule is not followed in other places - 293.

10. Some disorder groups appear in the full ICD in two places and the cross references have not been made here. For example, some dementias appear in 290 and 294. Those “of the Alzheimer’s type” are listed by DSM in the 290s and in the ICD side in the 294s. The crosswalk lists them in the 290s for the DSM side but in neither for the ICD side. Yet, if you read the actual ICD they are listed as a second diagnostic label in the 294s. In other words, using the crosswalk, you would never find them in ICD.

I am going to stop here (page 3 of the 16 pages in this crosswalk) but I suspect similar criticisms apply throughout.

Ed Zuckerman

1/8/05

PS: I have described this problem and offered to help to APA personnel at least 5 times.