September 24, 2018- Several recent studies report ICD Codes, specifically related to Lyme disease, have been considered and now rejected by the Centers For Disease Control (CDC) & the Maryland Department of Health as a "viable surveillance alternative".
As most know, these codes are designed to be used internationally. However, where the USA (CDC) stands on Lyme related issues- in this case opposing the ICD codes- typically other countries follow.
Study #1 (below), published in 2009, documents some of the problems regarding Lyme disease reporting and indicates better methods are needed.
Study #2 (below), published 9 years later, and during the time when a handful of people were trying to get new codes accepted by WHO, establishes that there continues to be a problem gathering reporting data and an alternative method is needed.
Study #3 (below) specifically states "administrative codes" are not the way to proceed with Lyme disease surveillance.
Study #4 (below), published 6 months later, indicates the CDC and Maryland Department of Health will continue to look for better answers.
TO NOTE- The American Medical Association (AMA) and the American Academy of Family Physicians (AAFP), amongst others, have lobbied against and sided with hospitals, Medicare and others to oppose and not use the new ICD codes in the past.
QUESTION- When will the new codes be available, IF they are approved?
ANSWER- "ICD-11 was released at this time to permit members to plan and prepare for implementation. ... In the United States, the typical process is for the Centers for Disease Control and Prevention (CDC) to evaluate the classification and clinically modify it.This process takes approximately four to six years to complete." Source
TO NOTE- The CDC will "evaluate" and "clinically modify" the ICD-11 codes. QUOTE- "Categories will include short (100 words) description and long (unlimited words) description." Will the CDC hurt us here or help us? Source
QUESTION- Will Post Treat Lyme Disease Syndrome (PTLDS) Be Listed? Will the CDC during its review add it to the list, being prompted perhpas by the IDSA, Hopkins, Yale, etc.?
ANSWER- A June 26, 2018 report from ICD Monitor states... There are a few new chapters in ICD-11, which include: ... Chapter 4 – Diseases of the Immune System, and Chapter V – Supplementary Section for Functioning Assessment." Source (See more information below.)
QUOTE- "...and two other [new] chapters are devoted to Supplemental V Codes — describing a patient’s functional status and disabilities — and Supplemental Extension (X) Codes —identifying more details such as severity, tumor staging, history, injury, poisonings and other attributes." Source
** To review the current draft of ICD-11 Codes Click Here. Click On- Browse The Release Version Here. Type the word Lyme in the search bar. To review the ICD-10 Code [Description] For Lyme Disease Click Here.
RECENT STUDIES
1.) CDC & Maryland Department of Health- 2009 Study
QUOTE- "In 2009, there were 120% more LD reports in Maryland than had been entered in the state database. Resources for LD surveillance vary by LHD, but have diminished overall. LHDs question the utility of LD surveillance and are eager for alternative approaches, such as querying billing databases. Source
2.) Maryland Department of Health- March 2018 Study
QUOTE- "These findings underscore the tremendous burden of LD on the public health agencies and highlight the need for alternative approaches that can both reduce burden and preserve surveillance data quality." Source
3.) CDC & Maryland Department of Health - March 2018 Study
QUOTE- "We explored the utility of International Classification of Diseases, 9th Revision, Clinical Modification (administrative) codes for use with LD surveillance. ... Grouping certain codes improved sensitivity, but our results indicate that administrative codes alone are not a viable surveillance alternative for a disease with complex manifestations such as LD." Source
4.) CDC & Maryland Department of Health- September 2018 Report
QUOTE- "Reasons for misclassification fell into three general categories: lack of clinical or diagnostic information from the provider; surveillance process errors; and incomplete information provided on laboratory reports. ... Knowing that misclassification of cases occurs during the existing LD surveillance process underscores the complexities of LD surveillance, which further reinforces the need to find alternative approaches to LD surveillance." Source
Additional Resources
QUOTE- "The primary focus of the JTF [Joint Task Force] is to recommend the subset of the ICD-11 foundation that will be included as codes in the ICD-11-MMS, used for international reporting, as well as how to appropriately structure those codes for tabulation and aggregation." Source
QUOTE- "Despite not being used in American hospitals, the ICD-10-CM code set has been revised yearly since 2003 to keep up with alterations made to ICD-10 by WHO. In preparation for ICD-10-CM implementation, a partial code freeze stopped the regular annual updates to ICD-10-CM codes in October 2011. Source
QUOTE (MEDICARE=CMS)- "According to a CMS message released Jan. 9, “CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any EP or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016.”... The influential American Academy of Family Physicians (AAFP) is among the groups hailing the CMS move." Source
QUOTE- "While non-HIPAA-covered entities aren't required to transition over to ICD-10, they can still adopt the coding system, which could potentially help the non-covered entities expand into more detail on injuries, for example. This added detail could then help organizations like automobile insurers and workers' compensation programs with injury classification and the coordination of benefits." Source
QUOTE- "Meanwhile, ICD-11 is under development now, and WHO will release the update in 2017.... The ICD-10 conversion in the U.S. was delayed by lobbying, politics and general opposition to the increased amount of codes in the newer set." Source
QUOTE- ..."...it won’t be until sometime... after 2022 that the United States is expected to adopt the codes of ICD-11 – the new International Classification of Diseases, Version 11... According to the WHO, the ICD-11 codes will be presented at the World Health Assembly next May for adoption by member states and could become effective as soon as Jan. 1, 2022. ... "...it will take the U.S. four to six years to clinically modify ICD-11, which is standard process. I hope that the U.S. will convert faster than they did for ICD-10.” Source
QUOTE- (History)
"Jan. 16, 2009 -- The U.S. Department of Health and Human Services (HHS) published a final rule establishing ICD-10 as the new national coding standard, with an adoption date of Oct. 1, 2013.
Aug. 24, 2012 -- HHS announced a delay in ICD-10 adoption from Oct. 1, 2013, until Oct. 1, 2014, to allow healthcare systems more time to prepare for the transition.
March 2013 -- At the 2013 HIMSS (Healthcare Information and Management Systems Society) meeting, a CMS administrator said ICD-10 would not be delayed past Oct. 1, 2014.
April 1, 2014 -- President Barack Obama signed a Medicare reimbursement bill from Congress that included a delay in ICD-10 implementation from Oct. 1, 2014, until Oct. 1, 2015." Source
QUOTE- "Entities that will use the updated ICD-10 codes include hospital and professional billing, registries, clinical and hospital departments, clinical decision support systems, and patient financial services." Source
QUOTE- "The 11th revision process is underway and the final ICD-11 will be released in 2018." Source
QUOTE- "The ICD is the foundation for the identification of health trends and statistics globally. It is the international standard for defining and reporting diseases and health conditions. ... It is the diagnostic classification standard for all clinical and research purposes." Source
More Information
American Medical Association (AMA) Opposes Implementing ICD-10
The ICD-10 Emperor Has No Clothes
WHO- ICD-11
An ICD-11 version for preparing implementation in Member States, including translations, was released on 18 June 2018.
ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States.
Following endorsement, Member States will begin reporting health data using ICD-11.
QUOTE- "There is no ‘deadline’ for countries to implement ICD-11. So just like with ICD-10, countries will implement at different times.” Source
QUOTE- (CDC) "Suggestions for modifications come from both the public and private sectors. Interested parties must submit proposals for modification prior to a scheduled meeting. Final decisions on code revisions are made through a clearance process within the Department of Health and Human Services.... Once proposals are reviewed all requestors will be contacted as to whether the proposal has been approved for presentation at the Coordination and ICD-10 Maintenance Committee meeting or not." Source
QUOTE- (CDC) "The ICD-9-CM Coordination and Maintenance Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10." Source
QUOTE- (MEDICARE) "The ICD-10 Coordination and Maintenance Committee (C&M) is a Federal interdepartmental committee comprised of representatives from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). The committee is responsible for approving coding changes, developing errata, addenda and other modifications." Source
QUOTE- (MEDICARE) "The Committee provides a public forum to discuss proposed changes to ICD-10. The first day of the meeting is devoted to procedure code issues and is led by CMS. The second day is devoted to diagnosis code issues and is led by CDC." Source
QUOTE- "The International Society for Disease Surveillance (ISDS), in collaboration with CDC, CSTE, and a workgroup with representatives from local, state, and military surveillance have developed and released a Master Mapping Reference Table (MMRT) that provides the concept mapping for over 130 syndromes that will assist agencies to modify existing database structures, extraction rules, and messaging guides, as well as revise established syndromic surveillance definitions and underlying analytic and business rules to accommodate the ICD-9 to ICD-10 transition. Source
Lucy Barnes