The Centers for Medicare and Medicaid Services (CMS) has released an update to the ICD-10 and Quality Measures website. The home page covers ambulatory surgical centers, hospital inpatient and outpatient, Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) Surgical Site Infections (SSI) Measures, CMS outcome and payment measures, Agency for Healthcare and Quality (AHRQ) Patient Safety Indicator (PSI) 90, Physician Quality Reporting System (PQRS), and Home Health.  There is also a Frequently Asked Questions (FAQ) document on the home page.

In other healthcare news, the Coordination and Maintenance Committee Meeting was held March 7 and 8 at the CMS headquarters in Baltimore, Md, for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) for fiscal years (FY) 2018 and 2019.  This article covers two topics: of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephaly (CADASIL) and lacunar infarcts.

CADASIL is an autosomal dominant genetic disorder caused by mutations in the Notch3 gene.   The condition causes thickening of walls of small arteries with loss of blood supply and impacts the white matter and deeper tissues of the brain. The most frequent symptoms are migraine headaches and mood disorders in patients in their twenties and thirties with strokes for patients in their forties and fifties. The multiple strokes lead to vascular dementia.    Death usually occurs within 10–20 years of the stroke and dementia onset.

A new subcategory has been proposed in ICD-10-CM of I67.85, which is described as hereditary cerebrovascular diseases. The proposed CADASIL code is I67.850. Instructions indicate that any associated diagnoses, such as stroke, epilepsy, and vascular dementia. A code has been established in the beta version of ICD-11 so there is a need to maintain consistency between the two code sets.

Lacunar infarctions are cerebral infarcts of small penetrating branch vessels deeper in the brain.   These infarctions have a favorable prognosis. The American Academy of Neurology has requested a distinct code that is specific to lacunar infarction.    This code proposal was initially discussed at the March 2016 Coordination and Maintenance Committee meeting, but the World Health Organization (WHO) was also discussing the addition of this concept. In October 2016, WHO approved the classification to I63.8. In March 2017 at Coordination & Maintenance Committee meeting, the lacunar infarct proposal with a new code for lacunar infarct of I63.81 and a separate code of I63.89 (another cerebral infarction) was discussed. There were no voiced objections.

Comments regarding the proposed diagnosis and procedure codes were due on April 7 with a request for expedited action. We look forward to seeing the results of the code discussions in June 2017.  For a sneak peak, review the Inpatient Prospective Payment System Proposed Rule for FY18, which is due any day.


Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

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