Translating DC: 03R into
ICD-9-CM Codes Florida’s Crosswalk
Kathryn Shea, LCSW
The Florida Center for Child and Family
Development
Sarasota, FL
kathryn.shea@thefloridacenter.org
Translating DC: 03R to ICD-9
Florida’s experience
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Brief History of IMH/DC: 0-3 in Florida
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September, 2000 Florida’s Strategic Plan for Infant
Mental Health finalized and published. This document
laid the groundwork for services, training, research
and policy changes.
Task force worked on policy changes specific to
Community Mental Health services for children ages
birth through five and their families
Policy approved and published by ACHA (Agency for
Health Care Administration)-Florida’s Medicaid agency
in May, 2002
Translating DC: 03R to ICD-9
Florida’s experience
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New policy recommended the use of
DC: 0-3 for assessment, diagnostic, and treatment
purposes, but required
ICD-9-CM code for reimbursement purposes.
December, 2001 in anticipation of new policy, Kathryn
Shea developed a “Crosswalk” between the DC: 0-3
and ICD-9 codes.
March, 2001 “Crosswalk” accepted as a guideline by
both the State Alcohol, Drug, and Mental Health Office
and ACHA.
May, 2006 Revised Crosswalk to correspond to new
DC: 0-3R and submitted to ACHA and SAMH for
approval. Crosswalk approved June, 2006.
Translating DC: 03R to ICD-9
Florida’s experience
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The Florida Center was part of the Florida
Infant Mental Health pilot project from 20002003 and had gained significant experience
in assessment/diagnosis of children birth to
age three and their families.
Approval of the “Crosswalk” allowed our
agency to continue services to these
children/families, as well as over 550
additional children/families since end of pilot.
Translating DC: 03R to ICD-9
Florida’s experience

Development of the Crosswalk –
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Impetus – Change in Medicaid Community
Mental Health Policy to specifically address
children ages birth through five and their
families with mental health problems.
Context – Policy recommended use of DC: 0-3
for assessment/diagnostic purposes, but still
required use of ICD-9-CM for reimbursement
The Bubble Bath Insight
The Imperfect Crosswalk
Translating DC: 03R to ICD-9
Florida’s experience
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Why crosswalk to ICD-9-CM and not
DSM-IV??
• Medicaid requires the ICD-9-CM code
• Easier for clinicians to crosswalk directly to
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one code
Higher probability of reimbursement if codes
are directly linked to required code
ICD-9-CM has different/varied codes that may
be more young child “friendly”
Translating DC: 03R to ICD-9
Florida’s experience
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Fall, 2005 - DC:0-3R published and released
Summary of changes:
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No longer includes Gender Identity Disorder
Removed “reactive attachment” from Reactive
Attachment Deprivation/Maltreatment Disorder of
Infancy
Renamed Traumatic Stress Disorder to Posttraumatic
Stress Disorder
Regulatory Disorders have been renamed Regulation
Disorders of Sensory Processing
Translating DC: 03R to ICD-9
Florida’s experience
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Summary of changes:
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Includes specific Anxiety Disorder subtypes in Anxiety
Disorders of Infancy and Early Childhood
Depression of Infancy and Early Childhood category
includes Major Depression and Depression NOS
Descriptions of Sleep Behavior Disorders and Eating
Behavior Disorders incorporate subtypes
DC: 0-3R recommends use of Multisystem
Developmental Disorder be restricted to children less
than 2 years of age
Translating DC: 03R to ICD-9
Florida’s experience
A “crosswalk” through the DC: 03R diagnosis
DC: 0-3R diagnosis
ICD-9-CM code
(refer to crosswalk handout)
Translating DC: 03R to ICD-9
Florida’s experience
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Florida’s Limitations
• Cannot bill for V codes on Axis I
• Florida Medicaid does not pay for community
mental health services for treatment of
autism, pervasive developmental delay, nonemotional or non-behavioral based
developmental disability, or mental
retardation.
Translating DC: 03R to ICD-9
Florida’s experience
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Implementation of the Crosswalk –
• Approval from SAMH/ACHA for use of the
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Crosswalk- Special Thanks to Sandra Adams,
Sue Ross and Catherine Goldsmith
Training on the Crosswalk, increased use by
clinicians across the state, multiple settings
The Florida Center uses primarily in child
welfare mental health services and outpatient
mental health services
Translating DC: 03R to ICD-9
Florida’s experience
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Training/Supervision Needs
• On-going in clinical group supervision
• Case studies/presentations in each group
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supervision
Video taping of assessments/treatment
sessions
Peer review of assessments/treatment
Linking with State/National IMH trainings
Translating DC: 03R to ICD-9
Florida’s experience
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Utilization within payors
• Medicaid has reimbursed for all assessments
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and treatment services billed for birth through
three clients using DC: 0-3 and R crosswalk.
Private insurance has reimbursed for 80% of
assessments/treatment services billed for
birth through three clients.
Translating DC: 03R to ICD-9
Florida’s experience
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The diagnostic dilemma
• The challenge does not lie in the
use of the crosswalk – the
challenge lies in the controversy
of diagnosing very young
children
Translating DC: 03R to ICD-9
Florida’s experience
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Evaluation of Crosswalk
• No formal evaluation or research done
• Is being used state wide for
reimbursement purposes
• Mental Health services being provided that
otherwise would not have been
• The Florida Center has provided
assessment/treatment services to over
550 children/families since DC: 03
Crosswalk approved
Translating DC: 03R to ICD-9
Florida’s experience
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Lessons Learned
• Bubble Baths are really good things
• Having good relationships with folks at
state levels that can make things happen
is a really good thing
• Supervision and Training needs to be a
high priority, yet fiscally difficult to do
Translating DC: 03R to ICD-9
Florida’s experience
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Promising Practices/Next Steps
• Diagnostic Decision Tree looks very promising
• Recommend Zero to Three produce video
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tapes of assessment/clinical discussion/
diagnosis/crosswalk code would be very
helpful (similar to ICDL Training Videotapes
on the DIR Model)
National data base on birth to three Axis I & II
Diagnosis w/ MH diagnosis in primary
caregiver
Medicaid Documentation
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Medicaid Made Easy – Simplify all you
can
• Create check lists for each file of what/when
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due
Create forms that makes it easier for the
workers, but gives Medicaid the information it
needs
Conduct trainings frequently (quarterly
minimum). The more the workers hear the
same information, the more it sinks in
Conduct peer supervision of charts to ensure
quality and accountability
Medicaid Documentation
It’s not about quantity of writing….
It’s about quality of writing and
incorporating all aspects of service
provision