POTTY PEOPLE MOBILIZATION!!!!

[Polly]

Z,

Don't forget mastocytic enterocolitis, which we seem to be seeing more of here.

Tex, thanks for your thoughts. I agree with Z. (and Dr. Fine) that LC and CC are on the same disease continuum. I believe he calls both MC. And I think that any path (microscopic) report that meets the appropriate definition should be called MC. The simpler, the better, IMHO!

Hugs,

Polly

[Zizzle]

Darn, just wrote a long post and hit the back button!! Here goes again, in shorter form.

I just had a long call with Donna Pickett of CDC's National Center for Health Statistics. Here's what we need to do:

There is a partial freeze on adding new codes. They are only considering new diseases unless we ask for expedited consideration.
Expediting would move implementation up a year, otherwise it's 2014.

We need to submit a proposal (preferably 2 pages or they will condense it for us) with the following:
-Background
-Rationale
-Frequency of Condition
-Bibliography (most relevant and recent sources - try to limit to 5)

Regarding the other less-known forms of MC, we need to decide whether they are worth fighting for, or whether they can remain under a "Other MC" category.

Deadline to submit our proposal is January 6 for presentation at the March 5-6 meeting here in DC.
We can find a clinician to present at the March meeting, NCHS clinicians can present on our behalf, or they will find one from one of the 4 gastro orgs they work with.
Our proposal will be vetted by these 4 groups (including AGA), so we might as well involve them earlier in the process.

Regarding the proposed coding, I'm thinking we'll want:

Keep the current code for other non-MC diseases:

K5289 Other specified noninfective gastroenteritis and colitis (existing code which includes MC, LC, CC and 25+ other forms of colitis)


New proposal:

K52x Microscopic Colitis
K52x1-LC
K52x2-CC
K52x3-ME
K52x4-Other specified Microscopic Colitis


Thoughts? Are you all on board?? Are we prepared to lobby the AGA on what should be an obvious decision? Should we involve Dr. Fine or some other expert(s) first?

[Zizzle]

Wouldn't you know, I found incidence research on the AGA website. Of course their patient education materials don't even mention the existence of MC. MC appears to be as common as UC and more common than Crohn's.

http://emedicine.medscape.com/article/1 ... view#a0156

In the United States, about 1 million people are affected with ulcerative colitis.[18, 19] The annual incidence is 10.4-12 cases per 100,000 people. The prevalence rate is 35-100 cases per 100,000 people. Ulcerative colitis is 3 times more common than Crohn disease.

Background & Aims: The burden and determinants of microscopic colitis (MC) in North America are inadequately defined. We determined the incidence rate of and risk factors for MC in a well-defined North American population. Methods: A population-based cohort study was conducted between April 1, 2002, and March 31, 2004. All adults with a pathologic diagnosis of MC were identified and comprehensive chart review was undertaken to confirm the diagnosis and identify risk factors. Category-specific risks for developing MC were reported as rate ratios (RRs) with exact 95% confidence intervals (CIs). Results: MC was identified in 164 individuals for an annual incidence rate of 10.0 per 100,000 person-years (lymphocytic colitis, 5.4; collagenous colitis, 4.6 per 100,000). Patients older than the age of 65 were more than 5 times more likely to develop MC (RR, 5.6; 95% CI, 4.0–7.7). Women were at higher risk of acquiring MC for both collagenous colitis (RR, 3.44; 95% CI, 2.07–5.97) and lymphocytic colitis (RR 6.29; 95% CI, 3.21–13.74). Elderly women with a history of malignancy were associated with a higher risk of MC (RR, 3.59; 95% CI, 1.68–7.01), as were patients with celiac disease (RR, 7.9; 95% CI, 4.0–14.2) and hypothyroidism (RR, 6.1; 95% CI, 3.5–10.0). Conclusions: This was a large population-based cohort study of MC and our incidence rates were consistent with previously reported population-based studies in North America and Europe. An increased incidence of MC was observed in several disease states with the novel finding of an increased risk of MC with malignancy.

http://www.cghjournal.org/article/S1542 ... 9/abstract

[tex]

I needed to look this up today, for another reason, but actually, what's so bad about the current designation? It appears to be:

K52.8 Other specified noninfective gastroenteritis and colitis

Collagenous colitis
Eosinophilic gastritis or gastroenteritis
Lymphocytic colitis
Microscopic colitis (collagenous colitis or lymphocytic colitis)

Why is that so bad?

Tex

[Zizzle]

Sorry Tex, I just noticed this post. I'm not sure where you got that list, but I can't find anything that lists MC as K52.8. MC/CC/LC are another decimal deep, K52.89. The issue is that these diseases are buried under K52 along with many other digestive diseases, when they should have equal prominence to Crohn's and Ulcerative Colitis. In other words, MC should not be in the decimals, LC, CC, ME (and EG?) should be single decimals under MC.

I don't see MC mentioned under K52.8 here:

http://www.icd10data.com/ICD10CM/Codes/ ... 52-/#K52.8

or here:

http://thcc.or.th/ICD-10TM/gk50.htm



But they are under K52.89:

http://www.icd10data.com/ICD10CM/Codes/ ... 52-/K52.89

If you have a medical billing professional keen enough to find K52.89 as the diagnosis code for one of the MCs, that's all you get, so we can't research the difference in incidence and prevalence between the various forms of MC. Even worse, many billers will not pick up on the "other" K52.89 code as representing MC, so people may be misdiagnosed with other diarrheal conditions or IBS on their billing, insurance, and Medicare records. Fewer diagnoses means less recognition, less interest and less resources for monitoring and curing the disease.

If MC happens at least as often as Crohns, it should aubsolutely be in a pre-decimal category, not hidden from public view.

IBS has its own code before the decimal:
http://www.icd10data.com/ICD10CM/Codes/ ... 5-K63/K58-

[tex]

I don't recall where I found that, at this point. I'm lucky to remember what I did yesterday. I hear you though, the system is pretty convoluted, especially for this class of diseases.

IBS has its own code before the decimal:

Yes, but that's because IBS is the favorite disease of most GI docs, so they need a code for it that's easy to find.

Tex

[Sharaine]

I wrote and got this automated response. Note I wrote before I got through the whole thread here. I still think it's good to get their attention and I can write to Ms. Pickett if needed.

Your feedback has been received.

Question Reference #111111-000118
Summary: Good evening. Today I received word there is no plan for a code for Lymphocytic ...
Product Level 1: Medicare
Product Level 2: Coding
Product Level 3: ICD-10
Date Created: 11/11/2011 07:59 PM
Last Updated: 11/11/2011 07:59 PM
Status: Fwd to Resource