February 29, 2016

How ICD-10 Supports Important Efforts of the WHO and CDC

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In its recent outbreak, the Zika virus, a mosquito-borne illness, has spread to more than 20 countries in South and Central America since May 2015. During a Feb. 1 news conference, Dr. Margaret Chan, director general of the World Health Organization (WHO), acknowledged just how serious the situation has become, describing it as “meeting the conditions for a public health emergency of international concern.”

This article explores the current coding of Zika virus, how ICD-10’s expandability will be used to track cases, and what’s ahead for the coding of other contagious and infectious diseases. 

Zika 101 

The Zika virus is transmitted via an infected mosquito from the Aedes genus, mainly Aedes aegypti, in tropical regions. This is the same mosquito that transmits dengue, chikungunya, and yellow fever. The virus first was detected in humans in 1952, when it was identified in both Uganda and the United Republic of Tanzania. Outbreaks of the Zika virus have been recorded in Africa, the Americas, Asia, and the Pacific. Symptoms, which typically last two to seven days, include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise, and headache. 

Coding Zika

Unfortunately, neither ICD-9 nor ICD-10 include specific codes for the Zika virus, making it more difficult than necessary for the WHO, the Centers for Disease Control and Prevention (CDC), and others to track the illness worldwide. In ICD-9, coders reported code 066.3 (mosquito-borne fever NEC). In ICD-10, coders report code A92.8 (other specified mosquito-borne viral fevers). 

However, once the partial code freeze is lifted on Oct. 1, 2016 (if not before), we’ll hopefully get a more specific code for this condition as it continues to affect additional geographic areas. 

ICD-10 Expandability  

The good news is that ICD-10 does include many code expansions and more specific descriptors for various contagious and infectious diseases. This is perhaps one of the most significant benefits of transitioning to this new and more stratified coding system. More specific data helps the WHO, CDC, and others gather information that affects how important public health decisions are made. 

Coded data also helps the CDC issue travel advisories for those venturing into countries where certain contagious and infectious diseases are more common.

Three More Diseases to Watch 

Following are a few examples of how ICD-10 provides greater specificity for several conditions listed on the CDC website that can affect travelers.

1. Ebola

With an average fatality rate of 50 percent, the Ebola virus is transmitted through close contact with the blood, secretions, organs, or other bodily fluids of infected animals (e.g., chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines). The first outbreaks occurred in 1976 in what is now Nzara, South Sudan, as well as Yambuku in the Democratic Republic of Congo. The Yambuku outbreak occurred in a village near the Ebola River, after which the virus is named.

Since then, the largest and most complex outbreaks have occurred in West Africa. Symptoms include the sudden onset of fever, fatigue, muscle pain, headache, and sore throat. Patients subsequently experience vomiting, diarrhea, rash, and symptoms of impaired kidney and liver function. Internal and external bleeding also occurs in some cases. 

Coding Ebola 

In ICD-9, coders reported code 078.89 (other specified diseases due to a virus). This vague code also included other conditions such as epidemic cervical myalgia and Marburg virus. Now, in ICD-10, we thankfully have a specific code for the Ebola virus disease: A98.4.

2. Typhoid fever

Typhoid fever is spread by coming into contact with contaminated food and/or water. The highest risk for typhoid fever is in South Asia. Common symptoms include high fever, weakness, stomach pains, headache, and loss of appetite.

Coding typhoid fever 

In ICD-9, coders reported code 002.0 (typhoid fever). They were not prompted to report any related complications separately. In ICD-10, however, there are seven codes in the A01.0- category that denote typhoid fever. These codes include: 

  • A01.00 (typhoid fever, unspecified)
  • A01.01 (typhoid meningitis)
  • A01.02 (typhoid fever with heart involvement)
  • A01.03 (typhoid pneumonia)
  • A01.04 (typhoid arthritis)
  • A01.05 (typhoid osteomyelitis)
  • A01.09 (typhoid fever with other complications) 

As noted above, five of the seven ICD-10 codes for typhoid fever also include the related complication. Physicians must link the complication with the typhoid fever when appropriate so coders can report the most specific code possible.

3. Chikungunya 

Chikungunya is another mosquito-borne illness that causes fever and joint pain. Those traveling to Africa, Asia, parts of Central and South America, as well as islands in the Indian Ocean, Western and South Pacific, and Caribbean all are at risk of contracting this illness.

Coding Chikungunya 

In ICD-9, coders reported one of two fairly vague codes: 065.4 (mosquito-borne hemorrhagic fever) or 066.3 (other mosquito-borne fever). ICD-10 includes a specific code for Chikungunya virus disease: (A92.0). 

Greater specificity bodes well for disease management 

The greater specificity inherent in ICD-10 allows entities such as the WHO and CDC to isolate where outbreaks are occurring and intervene more quickly. More specific data also enables disease prevention and supports patient education.

Take some time to review ICD-10 Chapter 1 to better understand new descriptors and code expansions for certain infectious and parasitic diseases. These codes truly make a difference in disease management. 

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