The view from here: ICD-11 and assorted September C&M diagnosis proposals

Sept. 28, 2022 / By Rhonda Butler

The September ICD-10 Coordination and Maintenance Committee (C&M) meeting held via Zoom Sept. 13 and 14 had a lopsided agenda—only four topics for proposed changes to the ICD-10-PCS procedure classification versus 37 topics for the ICD-10-CM diagnosis classification. Typically, I comment on the procedure code topics since ICD-10-PCS is my area of expertise. This time, since the meeting was overwhelmingly about ICD-10-CM, I am going to wear my audience hat and talk about other things I personally found interesting. 

ICD-11 contributes to ICD-10-CM updates 

Increasingly in forums where ICD-10-CM is discussed, how a concept is classified in ICD-11-MMS (ICD-11 for mortality and morbidity statistics, i.e., diagnosis codes) is part of the conversation. The C&M meeting is no exception. There were several times during the meeting when ICD-11 was used as a reference for ICD-10-CM changes. Commenters noted when a clinical concept was in ICD-11 and whether the proposed ICD-10-CM changes were consistent with ICD-11.  

Having been intimately involved in the transition to ICD-10-CM/PCS from ICD-9-CM I can tell you that this is a new thing … and I think it is fantastic! Even though we have no ICD-11 implementation timeline in the U.S., it makes such good sense to look ahead, be aware of what the next version of the ICD looks like and, whenever possible, to propose changes that will not conflict with ICD-11. 

The last time, political aspects of implementing ICD-10 sucked all the air out of the room—for years and years. I find it so refreshing to hear people talk about the substance of ICD-11 first. It should have been that way last time, but as in many other areas of life, “should” doesn’t get you very far.  

In any case, bravo to all of you who are investing now in learning ICD-11. For some of you this is not required for your job, this is something extra. Not only do I admire that in itself, I think you could be doing an immensely valuable service to the industry. If by talking about ICD-11 early and often it becomes a familiar part of the landscape, it may just be that the forces of obstruction won’t try to delay what is, after all, a planned update announced years in advance. We can hope. 

Diagnosis proposal highlights 

Here are a few proposals I found interesting, either for the proposal itself or for the audience comments. 

Acute HIV infection syndrome and HIV pre-exposure prophylaxis (PrEP) 

This term is used to refer to the initial infection with HIV and its accompanying symptoms and is clinically distinct from AIDS or later HIV disease. A code for acute HIV infection syndrome is in the World Health Organization (WHO) version of ICD-10, so this proposal is to bring the U.S. version in line with the WHO version. A new Z code is also proposed to track encounters for HIV pre-exposure prophylaxis (PrEP). PrEP is indicated for high risk individuals and a new code is proposed to increase awareness of PrEP and thereby ultimately to reduce the incidence of HIV. An audience comment suggested that a code for post-exposure prophylaxis might be useful to track early prophylactic treatment in situations such as sex trafficking and rape. 

Coronary microvascular dysfunction (CMD) 

This proposal for a new code is intended to track people diagnosed with ischemia with non-obstructive coronary arteries (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA). This will allow tracking of patients who experience angina or myocardial infarction and do not have any obstruction of the coronary arteries. The coronary microvasculature is a network of small arteries downstream from the larger, named coronary arteries on the surface of the heart and that distributes blood to the heart muscle. 

Eating disorders 

A few new codes and many includes notes are proposed for the eating disorder categories F50 and F98 to bring ICD-10-CM in line with the terminology used in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5). While this would seem a straightforward request, there was pushback from the audience on the issue of the includes notes. For example, includes notes for anorexia nervosa subtypes specified as “extreme” and those specified as “in remission” are associated with the same code. Because clinically a person with extreme anorexia is basically starving and has cardiac and endocrine problems, whereas someone with anorexia in remission is biologically and psychiatrically a completely different type of case, a commenter felt it would make more sense to add another axis of classification and create new codes to track those cases separately. The CDC responded that they had discussed this with the requester and the resulting proposal is what they wanted—a bunch of different stages of an eating disorder, all included in the same code. 

Foreign body entering into or through a natural orifice 

Any parent out there who has taken a child to the emergency department for help removing whatever it was they decided to stick up their nose or in their ear (bead, coin) or who has swallowed something not meant to be swallowed (battery, magnet), you may be surprised to know that there was almost no detail in ICD-10-CM to specify this type of incident. If audience hurrahs are any indication, that is going to change. There are a bunch of new codes proposed that name the specific foreign body, including all the examples in parentheses above and many others such as glass, rubber band, plastic toy and audio device (ear bud, hearing aid). Kids do the darnedest things—and now we will know precisely what. 

Obesity in children, adolescents and adults 

Based on feedback from the audience, this proposal may well come back with suggested revisions, so briefly I will say this: New codes are proposed to capture the current clinical stratification of obesity (class 1, class 2, class 3). In addition, terminology changes are proposed to eliminate stigmatizing language and reflect the current understanding of obesity as a “highly prevalent chronic disease with complex inflammatory and endocrinological pathophysiology.” 

If you would like more information on these or other diagnosis topics on the agenda, the meeting materials for the diagnosis portion of the meeting are on the CDC website. 

If you are interested in the procedure code proposals, the PDF of the procedure agenda, the clinical presentation slides and the Zoom recording are all available on the CMS website.  

If you would like to comment on any of the code proposals, send your comments by Oct. 14, 2022, for changes to go into effect April 1, 2023, and by Nov. 14, 2022, for changes to go into effect Oct. 1, 2023. Diagnosis comments go to NCHS/CDC at nchsicd10CM@cdc.gov. Procedure comments go to CMS at ICDProcedureCodeRequest@cms.hhs.gov. 

Rhonda Butler is a clinical research manager with 3M Health Information Systems.