Thoughts on the September ICD-10-CM Coordination and Maintenance Committee Meeting

Since I missed the September ICD-10 Coordination and Maintenance Meeting, which is typically one of my favorite annual events on the calendar, I have reviewed the diagnosis topics and am going to give you my thoughts.

As we head to ICD-11, it is my observation that the requests for changes in ICD-10 are becoming more and more specialized. They are often brought to the Centers for Disease Control and Prevention (CDC) by specialty groups, and I suspect that only the specialists will take advantage of many of them, if they are accepted into the coding schema.

That doesn’t mean they aren’t useful, but I think epidemiologists and researchers need to be aware that the statistics are likely underestimating the prevalence of many of the conditions associated with new codes.

We are living in the age of being able to identify genetic predispositions and chemical or immunological alterations without evidence of disease. There may be behavioral modifications, medications, or increased surveillance that are indicated to prevent the onset of pathology, so there is utility in making those early identifications. An ICD-10-CM code can explain why an action is being taken. Noting that a patient has an abnormal rheumatoid factor without rheumatoid arthritis is an example, requested code R76.81. It will be found in the R codes, under abnormal immunological findings in serum.

There were, and will be in the future, numerous proposals regarding specific codes for genetic neurodevelopmental disorders. Until recently, many conditions that manifest as intellectual disabilities, autism spectrum disorders, and epilepsy were lumped together.

Now that we have the ability to gene-sequence, we have the ability to discern between etiologies, and many organizations request specific codes to identify the specific syndromes. In fact, an entire new separate category is being proposed for neurodevelopmental disorders related to specific genetic pathogenic variants.

Our imaging technology is advancing, too. The Center for Drug Evaluation and Research, part of the U.S. Food and Drug Administration (FDA), is requesting codes to signify neuroimaging evidence of amyloid accumulation, with or without symptoms. Amyloid-related imaging abnormalities (ARIA) are proposed to be found in I68, and an instruction under G30, Alzheimer’s disease, recommends using them as additional codes, if applicable.

Multiple societies and the American College of Obstetricians and Gynecologists are requesting unique codes for specific types of ectopic pregnancies, such as Cesarean scar and cervical and interstitial ectopic pregnancies. These non-tubal ectopic pregnancies pose a higher risk of morbidity and mortality, and being able to identify them is important.

Eighty percent of the most common type of ovarian cancer occurs in women with no known risk factors, and bilateral salpingectomy greatly reduces that risk. Currently, patients who are undergoing gynecological surgery who opt to undergo opportunistic salpingectomy have no code to justify the procedure unless they have genetic or familial risk factors. In Z40.8-, they are proposing to add codes for prophylactic oophorectomy or salpingectomy without risk factors.

Staying in the OB-GYN realm, it’s hard to believe there wasn’t already a code for familial or personal exposure to diethylstilbestrol, DES, which was used between 1940 and 1971. Adverse consequences have been noted as far out as two generations from exposure. A request to rectify this was made.

A code specifying inflammatory breast cancer (IBC) is also being entertained. There are differences in presentation, treatment, and survival from IBC, as compared to other types of breast cancer. It is the hope that having a specific code will improve identification and facilitate earlier intervention.

I like the proposal of a Z98 code for “Postprocedural open deep wound without disruption” to signify a surgical wound intentionally left open. It is certainly clinically significant, even if it is iatrogenic pathology.

I look forward to a way to detail skin failure in L98, but I commented to the CDC that there should be a way to code verbiage of “skin failure” in which the provider doesn’t specify acuity.

A code for Type 2 diabetes without complications in remission is being proposed for patients who have normal glucose levels without treatment for three months or more. These patients have usually lost weight and no longer have abnormal glucose metabolism characteristic of T2DM. If diabetic complications have already ensued, this code isn’t applicable.

A new social determinants of health (SDoH) code of financial insecurity causing difficulty paying for utilities is being proposed at Z59.861.

A revised proposal to identify xylazine-associated wounds was also put forth. It consists of an ICD-10-CM code for toxic effect of xylazine with intent specification, along with the instruction to use an additional code for distinct new site-specified non-pressure chronic ulcers.

You should review the agenda and give the CDC your thoughts as well. That’s how we collectively shape the diagnosis code set.

Programming note:

Listen live when Dr. Erica Remer cohosts Talk Ten Tuesday at 10 Eastern today with Chuck Buck.