Diagnostic Codes

All disorders and conditions in the DSM-IV have unique codes

Some codes allow specification of the features and intensity of the disorder using the one or two digits to the right of the decimal.

These codes allow the clinician to specify:

-specific features of the disorder;

-severity of the disorder (mild, moderate, severe); and/or

-status of the disorder (e.g., residual, in remission)

To enter a diagnosis:

-enter the code

-enter the name

-enter the specifics, if any

Differential Diagnosis

A differential diagnosis presents those disorders that may explain the client's symptoms and which should be ruled out in order to reach the eventual diagnosis.

The eventual disorder/s that is/are not ruled out consitutes the committed diagnosis.

Differential diagnoses are the product of divergent hypothesis generation and testing.

Differential Diagnosis and Diagnostic Uncertainty

A Differential Diagnosis can reflect varying degrees of uncertainty.

When making a differential diagnosis, one can:

-Make a provisional diagnosis, with or without

specifying disorders to be ruled out;

-Make a broad diagnosis of a category of a

disorder (NOS), with or without specifying

disorder to be ruled out;

-Make a broad diagnosis of a psychotic or

nonpsychotic disorder with or without

specifying disorders to be ruled out;

-Diagnose the simple presence of a mental

disorder with or without specifying disorders to

be ruled out;

-Diagnose a non-mental disorder (i.e., a "V"

code) with or without specifying disorders to be

ruled out;

-Defer a diagnosis (799.90) with or without

specifying disorders to be ruled out; or

-Simply specifying disorders to be ruled out.

Ain't this grand??

Examples

Axis I: V799.90, Diagnosis Deferred (R/O 300.4, Dysthymia; 296.22, Major Depression, Single Episode, Moderate

Severity)

or

Axis I: 300.4, Dysthymic Disorder (R/O 296.22, Major Depression, Single Episode, Moderate

Severity)

or simply

Axis I: R/O 300.4, Dysthymic Disorder

R/O 296.22, Major Depression, Single Episode,

Moderate Severity

The Principal Diagnosis

Unless otherwise specified (using the term principal diagnosis):

-the principal diagnosis is the first one listed on

Axis I

If so specified:

-the principal diagnosis may be on Axis II

Example:

Axis I: 300.4, Dysthymic disorder, Early Onset, Secondary Type

Axis II: 301.83, Borderline Personality Disorder

(Principal Diagnosis)

Remember:

You may have more than one committed diagnosis on Axis I or Axis II

You may have one or more diagnoses on both Axis I and Axis II for a

given client

You must enter something on Axis I and II (i.e., if you are not making a diagnosis, enter V71.09, No Diagnosis, to indicate that you are not diagnosing a disorder or condition)

Also remember:

-some disorders subsume others

-disorders that are subsumed by others should not be

diagnosed as well

Provisional Diagnosis

A provisional diagnosis is one to which the clinican is not yet committed.

Specify a provisional diagnosis with the term (Provisional)

Example:

Axis I: 300.4, Dysthymic disorder (Provisional)

You may choose to specify diagnoses that should be ruled out in order to commit to the provisional diagnosis.

Example:

Axis I: 300.4, Dysthymic disorder (Provisional; R/O 296.22, Major Depressive Disorder, Single

Episode, Moderate Severity)

The provisional diagnosis is one means to communicate diagnostic uncertainty

Specifying Features of a Disorder

Features can be specified on Axis I or Axis II

Features are more often specified on Axis II

A client has features of a disorder when s/he exhibits some characteristics of the disorder, but not enough to actually diagnose the disorder

Example

Axis I: 300.4, Dysthymic Disorder, Primary Type

Axis II: V71.09, No Diagnosis, borderline personality

features

DSM-IV: Multi-Axial Diagnosis

Axes I and II are diagnostic axes

Axes III is for nonpsychiatric medical diagnoses that support diagnoses on Axes I and II

Axes IV and V provide further supporting information

The Axes

Axis I: Clinical Syndromes (Mental Diseases or Conditions)

Conditions not due to mental disorders

Axis II: Personality Disorders

Axis III: Relevant nonpsychiatric medical conditions

Axis IV: Nature of psychosocial stressors

Axis V: Global assessment of functioning rating (GAF)