Zoom scores one for democracy: March ICD-10 C&M meeting highlights

March 22, 2023 / By Rhonda Butler

It was Tuesday, March 7, and it (most likely) happened something like this … a coder or coding manager was watching the ICD-10 Coordination & Maintenance (C&M) virtual meeting on her computer screen. The clinical presentation was over, the proposal for new codes had just finished and the usual commenters had all had their say. She thought the proposal was a good idea but was not inclined to raise her hand just to say that. When the Centers for Medicare & Medicaid Services (CMS) summarized the comments, saying it sounded like there was general agreement for the change, almost without thought she put her thumbs up emoji in the chat window. It floated up the screen like a yellow balloon.  

Immediately more thumbs followed hers on the screen, some yellow and others in a variety of skin tones. And that was that. Thanks to our anonymous attendee, the silent majority had found its voice, and there was no turning back. When a familiar tool is used in a new way and when it’s right, in hindsight it looks like a no-brainer. It just takes that first person to show us. 

CMS did not hesitate to recognize the emoji as a form of public comment. The CMS analysts presenting the topics immediately began noting for the record the presence of thumbs up emojis showing general support for a proposed change. They even started asking for “a show of thumbs.” By the end of the second day, we were seeing thumbs, hearts, even the “oh no!” face when a presenter was describing the horrific effects of a disease or condition. I have to say, I found myself getting warm fuzzies over the whole deal. I thought, this is fantastic! Finally, audience members have found a way that works for them to vote their support. 

ICD-10 procedure highlights 

For ICD-10-PCS, applicants for the new technology add-on payment (NTAP) program continued to dominate the meeting. Many of these new technologies were variations on familiar themes, while others represented materials or electronics applied in novel ways.  

• Machine learning software—several proposals for new software intended to speed up identification of patients who could benefit from earlier diagnosis and intervention. There were separate proposals for codes to capture the use of software to help diagnose status epilepticus, acute stroke with large vessel occlusion and chronic heart failure.  
• Rapid identification of sepsis organism—two more proposals for new systems designed to rapidly identify the specific organism in cases of sepsis with positive blood cultures. There are already section X codes for other such systems, but these new systems claim to be more accurate, to have greater capacity, or both. The systems allow clinicians to use the appropriate antibiotic days earlier than with traditional methods (thereby avoiding overuse of broad-spectrum antibiotics). 
• “Smart” knee replacement prosthesis—contains internal sensors (3-D accelerometers and 3-D gyroscopes) in the tibial extension. It collects data on a person’s activity and gait after a knee replacement, sends the data wirelessly to a base station and then to an app, so the physician (and more importantly, the person with the synthetic knee!) can monitor their progress compared to others like them and optimize their routine to make the most of the new knee.  
• Open-truss ankle fusion device—an ankle fusion device for people who have bone defects from whatever cause, whether post-traumatic, from chronic disease such as diabetic peripheral disease or osteonecrosis, or from a congenital condition. The 3-D open-truss architecture (think geodesic dome) is packed with bone graft or other substitute and used to restore height. A standard intermedullary nail goes up through the center of the device and together they fuse and stabilize the joint. 
• Short term external heart assist systems—two proposals for impeller-style heart assist pumps. One is a new device placed in the thoracic aorta rather than the heart and used to treat chronic heart failure. The other proposal creates new codes to capture an additional arterial conduit already in use with the Impella 5.5. The new codes would track use of the modified system that allows patients to be ambulatory while wearing the pump and which therefore increases the approved use of the system from 4 days to 14 days. 

ICD-10 diagnosis highlights 

There were lots of proposals I found interesting. Here are brief summaries of a few. 

• Gulf War illness—proposes new codes to uniquely identify a subset of Gulf War veterans. These are people deployed between August of 1990 and July of 1991 who have sufficient symptoms to suggest exposure to one or more of a horrific list of toxic chemicals used in that war, including sarin nerve gas and pesticides. 
• Monogenic forms of obesity and obesity classes—two distinct proposals that aim to classify obesity more precisely. The first classifies obesity in the presence of a specific genetic mutation. The second is a revised proposal to create codes that use obesity classes (class 1, 2 and 3) to identify adults separately from children/adolescents. This is because children and adolescents may suffer from obesity with lower BMI numbers than in adults and so BMI by itself is considered insufficient information. 
• Central centrifugal cicatricial alopecia (CCCA) and frontal fibrosing alopecia (FFA)—both are forms of permanent hair loss. CCCA occurs mainly in women aged 30-55 of African descent and affects the crown of the head extending outward. FFA occurs mainly in postmenopausal Caucasian women and affects the forehead extending back.  
• Post-exertional malaise/post-exertional symptom exacerbation (PEM/PESE)—a proposed new symptom code to track PEM/PESE. According to the requestor this code is necessary to track patients with long COVID-19, which is currently absent from the electronic health record (EHR). This new code could also be used for individuals with PEM/PESE who have not received a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 
• Encounter for sepsis aftercare—proposed new Z code to identify sepsis survivors. According to the data, people who have suffered a bout of sepsis face a recovery period that is complex and can last months to years. A code to identify this group will enable more effective delivery of post-acute care for them. 

For more details, the meeting materials for procedure codes are on the CMS website and the meeting material for the diagnosis codes are on the Centers for Disease Control and Prevention (CDC) website. Both PDFs are bookmarked so you can easily click to topics that interest you. If you want to see what voting by emoji looks like, the links to the Zoom recording and passwords for both days of the meeting are all on the CMS website as a downloadable PDF. 

If you choose to comment in writing on any of the code proposals, the email addresses and deadlines are: 

For procedure code proposals, send comments by April 7, 2023, to CMS at ICDProcedureCodeRequest@cms.hhs.gov. For diagnosis code proposals, send comments by May 8, 2023, to National Center for Health Statistics (NCHS)/CDC at nchsicd10CM@cdc.gov. 

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