EVALI, VAPI, Let’s call the whole thing off!

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Original story posted on: November 19, 2019

Providers and the CDC may be setting up a coding-clinical disconnect.

EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Nov. 19 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting.

Since I don’t practice clinically anymore, it is challenging to keep up with current medical best practices. Occasionally, I get emails from societies, which I scan for topics that interest me, and over the weekend, an edition of the ACEP (the American College of Emergency Physicians) Weekend Review popped up in my email.

The article, titled, What You Need to Know About Vaping-Associated Pulmonary Injury, led to an online electronic publication, ACEP Now, and it details the outbreak of lung injury we are seeing as a result of vaping, reported by Joshua Farkas, MD. Laurie Johnson has been reporting on this for us at ICD10monitor, and has told us that the term the Centers for Disease Control and Prevention (CDC) has adopted for the condition is EVALI, or electronic cigarette/vaping associated lung illness. The ACEP article refers to the condition as “vaping-associated pulmonary injury,” or VAPI.

The unfolding of this condition in real-time is fascinating for the medical community (but it is never good, in medicine, to be “interesting”). It reminds me of when I was in medical school when this new condition called acquired immunodeficiency syndrome was discovered. But EVALI is being recognized, investigated, and acted upon exponentially faster than AIDS was.

The problem is that providers and the CDC may be setting up a coding-clinical disconnect. Proposals for a new code for this medical condition are planned to be presented at the ICD-10-CM Coordination and Maintenance Committee meeting in March 2020. If a code for EVALI is established and the indexing corresponds, but the term VAPI takes hold in the clinical community, our data may be flawed, because we may miss cases. Either the providers need to transition to using the acronym EVALI, or we need to make sure that “vaping-associated pulmonary injury” and “VAPI” are legitimate inclusion terms.

The funny thing about the Farkas article is that it links to the CDC Update page: Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury - United States, October 2019, which utilizes EVALI as the acronym. It would have been a good idea for the author to mention that the acronyms did not match. I felt compelled to leave a comment on the site pointing this out. I also suggested that it would be optimal for providers to type in “EVALI,” and their electronic medical record should output an enterprise-wide acronym expansion, “EVALI (electronic cigarette/vaping lung illness).” This leaves no ambiguity or doubt to the reader. Hopefully, this condition will not become widespread, and future providers will not be familiar with it (or its acronym).

Another related article from the CDC is worth mentioning. Cigarette Smoking Among U.S. Adults Lowest Ever Recorded notes that the rate of cigarette smoking is at an all-time low of 14 percent. This is great news because It is believed that cigarette smoking leads to approximately one-third of cancer deaths. However, 47 million adults still use some type of tobacco products, when you add in the electronic and smokeless products.

Sometimes it takes time to identify all the harm a behavior poses. EVALI may turn out not to be the only risk. The contribution of vaping to cancer is not yet clear.

Programming Note:

Listen to Dr. Erica Remer live during Talk Ten Tuesday every Tuesday, 10-10:30 a.m. EST.

Erica E. Remer, MD, FACEP, CCDS

Erica Remer, MD, FACEP, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

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