The new ICD-10 codes are fully implemented, and some of these diagnostic codes are implausible at best. For instance, code “V97.33XD: Sucked into jet engine, subsequent encounter” is absurd given the likelihood of surviving initial entry into the jet engine. There is also “Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter.” I believe this may not be in accordance with the laws of physics. According to preliminary feedback from primary care providers, the new ICD-10 coding system is frustrating and taking time away from patient care.1 The modifications in codes for asthma were especially far-reaching, and these changes are particularly time-consuming for primary care providers who often treat patients with asthma.

The new ICD-10 codes for asthma may seem daunting, but there could be a silver lining to the new system. Previous ICD-9 codes for asthma were based on a clinician’s ability to determine whether the patient had extrinsic (allergic) or intrinsic (exercise- or irritant-induced) asthma. For a majority of providers, this information is unknown unless the patient had previously undergone allergy skin prick testing or serum RAST testing. The new ICD-10 codes require the clinician to classify asthma into different levels of severity.

Asthma continues to be one of the top reasons for emergency department visits (CDC, 2011). A recent article in BMJ pointed to a number of different reasons for inadequate asthma control and mortality rates, including use of asthma action plans, appropriate prescription therapy, and more closely followed care.2 This article noted that 70% of the patient deaths reported were due to primary care failings in routine care, and an additional 59% of asthma deaths occurred when asthma guidelines were not followed (Torjeson, 2014). According to the National Heart, Lung, and Blood Institute (NHLBI) guidelines, stratifying asthma severity is standard of care for asthma management.3

Asthma severity classification is straightforward, and the new ICD-10 coding system will force providers to determine asthma severity at every patient encounter. Unfortunately, patients are often unaware of the severity of their asthma. A majority (55%) of patients receiving prescription asthma medications are considered uncontrolled using the NHLBI guidelines.4 

It is up to providers to ask straightforward questions about symptom frequency and use of rescue inhalers to stratify asthma control and severity. If a patient is requiring a rescue inhaler daily, his or her asthma severity is either moderate or severe persistent. A patient with this level of asthma severity should be on a minimum pharmaceutical regimen of daily inhaled corticosteroids or moderate-dose combination inhaled corticosteroid/long-acting beta agonist therapy. If the patient’s asthma control classification does not match his or her prescription therapy, it would be imperative to reconsider treatment options.

The new ICD-10 coding system may seem inappropriate for some disease models, but asthma care may benefit from the required changes. Once providers begin taking a closer look at asthma control, it stands to reason that prescription therapy will be more appropriate. Take the time to ask specifically about your patients’ rescue inhaler use, and quantify their level of asthma control. It may lead to improved patient outcomes, reduced emergency room visits, and happier patients.

Laura Odom, DNP, FNP-BC, is a clinical assistant professor at the University of Tennessee, Knoxville, and is the president and co-founder of Medic Apps, LLC.

References

  1. Natale C. ICD-10 transition has increased frustrations for physicians. Healthcare IT News & Healthcare Finance. Published October 10, 2015.
  2. Torjesen I. Two thirds of deaths form asthma are preventable, confidential inquiry finds. BMJ. 2014:348. doi: 10.1136/bmj.g3108
  3. National Heart, Lung, and Blood Institute. Guidelines for the diagnosis and management of asthma. Summary report. Published 2007. 
  4. Peters SP, Joes CA, Haselkorn T, et al. Real-world evaluation of asthma control and treatment (REACT): Findings from a national web-based survey. J Allergy Clin Immunol. 2007;119(6):1454-1461