Gender Dysphoria: A New Patient Population We Need to Understand and Embrace

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Original story posted on: August 19, 2019

There is an ICD-10 code for gender dysphoria.

Recently, the Family Equality Council (FEC) published a comprehensive research study featuring some inspiring statistics, all of which point to the fact that the number of LGBTQ+ families in the United States is set to grow dramatically in the coming years. In fact, the report states that 77 percent of LGBTQ+ millennials (ages 18-35) are already parents or are considering having children, a 44 percent increase over previous generations.  

In light of this, it’s time for primary care physicians and all medical providers to make their practices more inclusive and welcoming to the specific needs of this patient population. However, creating an inclusive practice for the LGBTQ+ community requires time and intention.

Alternative medicine clinics are also starting to provide services for the transgender patient community and to continue with that inclusivity and forward-thinking education, let’s discuss a condition called gender dysphoria. What is gender dysphoria?

First, to understand the diagnosis, you need a refresher on some terminology definitions.

Sex

Gender

The anatomy of an individual's reproductive system and secondary sex characteristics.

Example: breasts, reproductive organs.

The performance or expression of one’s identity, or either social roles based on the sex of the person (gender role) or personal identification of one's own gender based on an internal awareness (gender identity).


So, what is gender dysphoria? It is a diagnosis, determined by a medical professional when one’s gender assigned at birth does not match the gender with which an individual identifies, and they experience significant distress as a result. According to DSM-5, (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders),
“for a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months.”

Note: “transgender” is an umbrella term used to describe individuals whose gender identity, one’s inner sense of being male, female, or something else, differs from their assigned or presumed sex at birth.

“It is important to note,” DSM-5 states, “that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition. In children, the desire to be of the other gender must be present and verbalized.”

Gender identity disorders in ICD-10-CM start in the F64- code series. They are characterized by a strong and persistent cross-gender identification (such as stating a desire to be the other sex or frequently passing as the other sex), coupled with persistent discomfort with one’s sex (manifested in adults, for example, as a preoccupation with altering primary and secondary sex characteristics through hormonal manipulation or surgery).
 
ICD-10-CM Codes ▪ F64
F64 Gender identity disorders •
    • F64.0 Transsexualism
    • F64.1 Dual role transvestism
    • F64.2 Gender identity disorder of childhood
    • F64.8 Other gender identity disorders
    • F64.9 Gender identity disorder, unspecified (Gender Dysphoria)

According to Psychology Today, the level of distress experienced by someone with gender dysphoria is significant, and individuals do much better if they are in supportive environments, allowed to express their gender in the way that’s most comfortable to them – and are given knowledge that, if necessary, treatments exist to reduce the sense of incongruence they feel. This acceptance should extend to their physician’s office.

This is why it is so important, in today’s climate of the ever-changing patient profile, that we as healthcare professionals embrace a different attitude and recognize that staff needs training not only on the ICD-10-CM associated conditions for these patients, but also in inclusiveness when it comes to language in the practice, on intake forms, and in conversations in general.

While some individuals manage to overcome symptoms of distress on their own, a sign and/or symptom that leads to the gender disorder can be assigned ICD-10-CM codes. An understanding by healthcare professionals of the concepts, terminologies, and challenges these patients feel when they walk into your practice can often be very helpful in bringing about the personal discovery that facilitates self-comfort, and in dealing with strong emotions that may have resulted from peer-related challenges or social stigma, for these potential patients.

The best outcomes for those with gender dysphoria are associated with early diagnosis, a supportive environment, and comprehensive treatment that respects the wishes and desires of the patient. This can start at the physician practice, staff, and coding staff level. Be proactive when researching and embracing alternative medicine models. They are here to stay, and maybe a significant population visiting your practice in years to come.

Programming Note:

Listen to Terry Fletcher report this story live today during Talk Ten Tuesday, 10-10:30 a.m. EST.

Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS,  ACS-CA, SCP-CA, QMGC, QMCRC

Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC, is a healthcare coding consultant, educator, and auditor with more than 30 years of experience. Terry is a past member of the national advisory board for AAPC, past chair of the AAPCCA, and an AAPC national and regional conference educator. Terry is the author of several coding and reimbursement publications, as well as a practice auditor for multiple specialty practices around the country. Her coding and reimbursement specialties include cardiology, peripheral cardiology, gastroenterology, E&M auditing, orthopedics, general surgery, neurology, interventional radiology, and telehealth/telemedicine. Terry is a member of the ICD10monitor editorial board and a popular panelist on Talk Ten Tuesdays.

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