When you look at DSM-5 diagnoses, you will see a DSM-5 code (e.g., 302.85) and an ICD-10 code in parentheses (e.g., F64.0). As most insurance companies require ICD codes, this assists the mental health professional in locating the most relevant code for billing purposes. Two examples follow.

Gender Dysphoria in Children 302.6 (F64.2)

Gender Dysphoria in Adolescents and Adults 302.85 (F64.0)

Not only has the DSM changed over time in terms of how mental health professionals conceptualize gender identity related diagnoses, so has the ICD-10.

While the DSM-5 includes suggested ICD codes for the DSM-5 diagnoses, the symptom lists/diagnostic criteria are not identical to one another in the DSM-5 and ICD-10. Let’s think about the ethical practice of psychology.

What is the most ethical way to practice? Of course, the questions which follow do not apply only to gender dysphoria. These are issues that could apply to other diagnoses, as well where the DSM-5 and ICD-10 criteria are not identical.

1. If ICD-10 criteria are not identical to DSM-5 criteria in all cases, is it ethical to simply take the ICD-10 codes listed as equivalent without verifying the client/patient fully meets the criteria in the actual ICD-10?

2. Take the role of a psychologist or psychiatrist. Your client desires reassignment surgery and you believe there is greater than a 50% possibility that the surgery might have a beneficial impact on your client/patient. The client/patient meets the criteria for gender dysphoria in the DSM-5. You must turn in an ICD-10 code. The client/patient closely meets the ICD-10 criteria, but not quite. In your opinion, would it be ethical to turn in the ICD-10 code to recommend the client receive the desired surgery?

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