January 11, 2016

Chronic Traumatic Encephalopathy (CTE) and ICD-10

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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.

 

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 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 and will be speaking at 2017 AHIMA Coding Community Meeting in Los Angeles, Ca. Laurie has been a frequent guest on Talk Ten Tuesdays.

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