Asthma, patient engagement and ICD-10 are a hand in glove fit. That is because few if any other health conditions exemplify the importance of patients’ involvement in their health care which will exist in the wake of the ICD-10 transition. The primary reason patient engagement will play a more important role in the management of asthma is not only are the ICD-9-CM-and ICD-10-CMcodes for asthma different. The codes have totally different meanings and their correct use for billing and reporting will depend more on information patients provide than the ICD-9-CM coding system does.
Under the current ICD-9 coding system there are three main codes for asthma. They are for extrinsic asthma (allergic asthma), intrinsic asthma (nonallergic asthma) and chronic obstructive asthma (asthma with COPD). The ICD-10-CM coding system does not have codes for any of these descriptors. Instead, its codes focus more on the severity and frequency of the asthma symptoms. Therefore, patients will need to be able to provide physicians with the necessary information to create accurate medical documentation which supports the meaning of the codes they use.
The link between the treatment of asthma and ICD-10-CM is the currently endorsed international asthma classification system. An expert panel of the National Heart Lung and Blood Institute (NHLBI) devised the system in 2007. It serves as a guideline for diagnosing and treating asthma. It also classifies asthma based on a number of variables. The classification for a given patient is that of the variable(s) with the highest severity rating(s). The criteria are as follows:
- The frequency of asthma symptoms
- The severity of asthma symptoms
- Frequency of use of a short acting beta agonist
- Pulmonary function
- Number of exacerbations per year requiring treatment with an oral corticosteroid
The symptom frequency variables classify asthma as intermittent or persistent. Intermittent means asthma symptoms occur two or fewer days per week. Persistent consists of mild, moderate and severe subcategories based on whether symptoms occur greater than two days per week, daily, or throughout the day respectively.
The symptom severity classification variables are as follows:
- The number of nighttime awakenings per week
- The number of times per day a short acting beta agonist has to be used to control symptoms
- The degree to which asthma symptoms interfere with normal activity
The portion of the NHLBI classification system based on symptom frequency and symptom severity fits nicely with the ICD-10-CM classifications of mild intermittent, mild persistent, moderate persistent and severe persistent asthma.
The stitches joining patient engagement to this health care triad though are:
- The need for patients to keep records
- The lung function criteria for asthma classification
A patient record of the frequency and severity of symptoms is better than reliance upon rote memory at the time of a doctor visit. The reason is it is more likely to be accurate and meet the classification and ICD-10-CM medical record requirements.
A general patient diary might work, but one customized to capture the necessary information might be a better alternative. Customized forms are also an option. Regardless of the method of recording information, it is best to take it with you during doctor visits or send it to your doctor in advance of visits if that is preferred.
In addition to the frequency and severity of symptoms the record should also include the number of times per day you have to use rescue medication for symptoms. Additionally, you should record the number of times within a year a doctor treats you with a corticosteroid for an exacerbation of your asthma, if applicable. The latter is particularly important if you are seeing a new doctor who is not familiar with your medical history.
The officially recognized lung function criteria for classifying asthma are measurements of the FEV1 and the FEV1/FVC. A respiratory therapist makes these measurements during the process termed spirometry. As such, it is not a patient engagement activity. But a patient engagement activity which assesses lung function in a different way is the measurement of peak flow rates with a peak flow meter.
Peak flow measurement criteria are not an explicit part of the current asthma classification system, even though they are implied is an alternative to spirometry. Many healthcare providers consider them to be equivalent to spirometry for classifying the severity of asthma.
The percentage of predicted normal flow rates achieved during the testing is what determines the severity of the asthma grade. Age, gender and height predict what an individual’s normal measurement should be. The criteria currently used are as follows:
- Peak flow rate >80% of predicted – Mild asthma
- Peak flow rate 60% – 80% of predicted – Moderate asthma
- Peak flow rate <60% of predicted – Severe asthma
You should record the best (not the average) of two or three back-to-back readings. You should chart that reading and give it to your doctor for placement in your medical record. Many experts consider daily measurements during the 2 to 3 weeks prior to a doctor visit to be representative of the current severity status.
Whether you elect to record all of the sets of data discussed above or just some of it, the important thing is to have enough for your doctor to justify the use of the ICD-10-CM codes pertaining to your treatment. It is unlikely that insurance companies in general will have ironclad rules regarding the medical documentation of asthma severity. They will require that it be pertinent and reasonable though. Patient engagement will be the basis of that reasonableness.
Meaningful patient involvement in the treatment of asthma will not just be about proper reporting and billing within the ICD-10-CM coding system. Even now, physicians use symptom records, peak flow rate data or a combination of both to tailor the treatment of asthma patients. Much like patient engagement in the management of many other diseases, it should help improve health care and health care outcomes for patients with asthma.