The author ruminates on the Fall C&M meeting.

EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 17 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting.

I listened to the ICD-10 Coordination and Maintenance Committee Meeting last week. Here are my thoughts.

There are narrow conditions that are championed for their own codes. On principle, I support specific diagnoses having unique codes. If you treat patients with Friedreich ataxia, you likely want to know the prevalence. If a drug or a gene therapy is developed which can treat Nemaline myopathy, you might want the condition teased out of the group of congenital myopathies so you can link the treatment with the disorder. But I am not sure I really care one way or the other if Powassan Virus Disease which had 21 cases in 2018 has its own code.

I think that societies and providers who petition for granular codes need to accept that there are large groups of providers who will not take advantage of the granularity but will fall back on unspecified codes. For instance, the sickle cell code set is being proposed to expand to sickle cell-thalassemia beta zero and sickle cell-thalassemia beta plus. You are not going to get the average emergency physician caring for a patient in a pain crisis to take advantage of ICD-10’s specificity. Consequently, changing the code set is not going to facilitate tracking patients sorted by sickle cell type.

It irks me when they use non-medical terms. They want to add specificity to the site of thoracic injuries, such as right and left anterior thorax. I requested they use the word, “midline,” instead of “middle,” for injuries that are neither right nor left.

For the tabular changes, I was ecstatic to see them add non-novel Influenza A, Influenza B, and Influenza C as inclusion terms for “other identified influenza virus.” I thought I didn’t support removing “peritonitis” as an inclusion term for diverticulitis, but on further review, I noted in the instructions that you are supposed to code also the type of peritonitis, so I don’t think it will be a problem. As many codes as it takes!

My final comment on the proposed tabular addenda regards atherosclerosis and adding limb ischemia. I think it is great to add limb ischemia to get to a code, but I am not certain that all providers use the word, “critical,” as a mandatory modifier. They will be very irritated to get queried for that word, if they documented, “limb ischemia.”

I think having specificity for the etiology of immunodeficiency will be useful. If it is due to taking a long-term medication or adverse effect of a drug, you use an additional code.

They also are trying to split out the central nervous system malformations and chromosomal abnormalities, but there is no plan to split out other body systems, like cardiac, GU, or musculoskeletal.

This led to one of the liveliest discussions we had. Having a fetus designation explodes the code set tremendously because there are seven 7th characters for the number fetus. They are considering bringing forth a proposal in the future divorcing fetus designation from the condition. I supposed they would devise a Z code, like the Z code set for which week of pregnancy. I think the question is, “Does it matter which fetus has which condition while they are in-utero?” I’m not an OB or a neonatologist, so I am not sure whether it is critical or not.

Sadly, I was at the doctor’s office with my dad for the sepsis discussion. I think all sepsis circumstances should have an additional code for the type of sepsis including organism, if available. I don’t see why puerperal sepsis would have an Excludes1 when sepsis during labor or following abortion has a Code first. I also think there should be an unspecified viral and fungal sepsis code. Would make SEP-1 exclusions easier.

The last point, fentanyl, and tramadol are getting their own T codes.

Read the proposals and send in your comments.


Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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