Updated on: November 28, 2016

Chronic Traumatic Encephalopathy (CTE) and ICD-10

By
Original story posted on: January 11, 2016

In December, the movie “Concussion” was released.  It tells the intriguing story of an investigation into repetitive concussion injuries and the National Football League (NFL).

 

This story really hit home for me personally, as I was born, raised, and currently live in the Pittsburgh area – and Pittsburgh Steelers Hall of Famer Mike Webster was the case with which this investigation began. “Iron” Mike Webster, after completing his playing career, suffered from a downward spiral of events that led to his death at the age of 50.   

The story was huge in the Pittsburgh area. Dr. Bennet Omalu, a forensic pathologist in Allegheny County, began to investigate Webster’s death to understand why a healthy man died so young. His investigation found that Mike suffered from repetitive injuries to the brain during his playing career – a condition Dr. Omalu named chronic traumatic encephalopathy (CTE). The movie goes on to describe how the investigation continued on to Justin Strzelczyk, Terry Long, Andre Waters, Junior Seau, and Dave Duerson: all former NFL players who died at an early age by their own hand.

After seeing this movie, I began reviewing the codes for CTE and found there is one code: F07.81 (postconcussional syndrome).

There are instructions that for a current injury, the coder should refer to injury, intracranial. Under the code F07.81, the coder should also assign a code for any associated post-traumatic headache (G44.3-), if applicable. If the coder was coding a current concussion, then that condition would be found under S06.0-.

Yet this code seemed woefully inadequate to describe the symptoms of personality change (F68.8), hallucinations visual (R44.1) and auditory (R44.0), generalized pain (R52), depression (F32.9), difficulty with spouse and family (Z63.0 – Z63.9), etc.

The external cause codes of suicide attempts can be added from the X71-X83 (self-harm) section. Problems with adjustment to retirement (Z60.0) and homelessness (Z59.0) can be added to describe the social situations of these players as well. As you can see, with the additional external cause codes, a picture can be painted about the sufferers of this disease.

Even though ICD-10-CM contains a large number of codes – over 68,000 in all – we are still finding that there will need to be additional codes added. The need will expand as we continue to find new uses for structured data.

Another Medical Necessity Impact of ICD-10

ICD10monitor has been reporting on ICD-9-CM-to-ICD-10-CM/PCS translation issues related to the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). Another recent development in this vein involves the coverage for carotid stenting.

In 2005, there was a decision regarding the medical necessity of carotid stenting, after which very specific guidelines were published dictating that each facility performing such procedures must be approved to do so by the Federal Drug Administration (FDA).

With the transition to ICD-10-CM/PCS, the procedure codes have been translated to the new code set. The inpatient codes include extirpation of the carotid arteries (e.g. 03CJ3ZZ), which now is included in the NCD for percutaneous transluminal angioplasties (PTAs). There have been reports of facilities experiencing claim rejections due to this NCD.

It is recommended that if you are experiencing difficulties with claim rejections, reach out to your Medicare Administrative Contractor (MAC) and the ICD-10 ombudsman so that the issue can be resolved.

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (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 makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • Things Your Mother Never Told You About HCC: Version 23
    The 2019 CMS risk adjustment model is version 23. The Centers for Medicare & Medicaid Services (CMS) released, in April, the latest update to the CMS-hierarchical condition category (HCC) Risk Adjustment Model (V23).  It applies to payment year 2019.  As…
  • Random Thoughts about ICD-11
    New classification system noted for granularity. Several of my colleagues recently attended an ICD-11 presentation by Kathy Giannangelo[i] at the American Health Information Management Association (AHIMA) Convention & Exhibit. Kathy has been in the trenches with ICD-11’s development for some…
  • Navigate Medical Marijuana with your Eyes Wide Open
    A lesson in coding and policy.Medical marijuana, or cannabis, as it is commonly referred to in the healthcare field, is allowing chronically ill patients to relieve painful, often debilitating symptoms legally instead of taking pills many claim do little to…