Critical limb ischemia, also known as chronic limb-threatening ischemia, is an undertreated disease that often leads to amputation and/or mortality. One reason for undertreatment and underdiagnosis was coding.
Until recently, the ICD-10-CM did not offer an easy way to code CLI/CLTI. This lack of recognition compounded the problem of patients with peripheral artery disease being diagnosed with CLI/CLTI late, sometimes at which point the only recourse was amputation, or not being diagnosed at all until after death.
The CLI Global Society formed in 2016 to improve the quality of life of patients with CLI/CLTI by limiting amputations and mortality and to collaborate with other organizations to address issues such as treatments, long-term outcomes, coding and reimbursement.
Healio spoke with Robert Lookstein, MD, MHCDL, FSIR, FAHA, FSVM, professor of radiology and surgery, vice chair of interventional services and medical director of the supply chain at Mount Sinai Health System, a board member of the CLI Global Society and chair of the Vascular Societies Workgroup, about how the new code changes came about, how it will work in practice and what it means for patients and clinicians.
Question: What problems arose from CLI/CLTI not having its own ICD-10-CM codes?
Lookstein: A recent publication by the CLI Global Society confirmed that CLI/CLTI is an underdiagnosed and undertreated deadly disease that requires proper diagnostic imaging, early intervention and increased awareness. Yet, ICD-10-CM, the only medical coding language for diagnoses in the U.S., derived from the international version, did not distinctly identify this patient demographic. This problem highlighted the significant challenges of tracking patient incidence, outcomes, disparities and costs to the health care system, and impedes our ability to recognize the true impact of the disease. The goal became to identify and define CLI disease consistently and to support the myriad coding professionals, educators, compliance staff and physicians who will report and monitor patient treatments and outcomes in the future.
Q: How long has the society worked on coding issues?
Lookstein: This project was started in late 2017. The interaction with the CDC began in 2019 with a proposal submission from the CLI Global Society and the multisociety workgroup, which was approved in its entirety for implementation on Oct. 1.
Q: What do you think persuaded the CDC to approve the code changes?
Lookstein: The fact that there was consensus and support for this effort from all the major vascular specialist organizations — SVS, SIR, SCAI and SVM — reinforced the need to clearly identify patients who present with clinically advanced stages of PAD known as CLI or CLTI. We all believe there is a need to distinguish CLI/CLTI from the general diagnosis of PAD as it was previously defined in the ICD-10-CM. To accomplish this, the CDC did not need to create a single new diagnosis code for the ICD-10-CM; rather, it now links the terms “critical limb ischemia” and “chronic limb-threatening ischemia” for a subset of ICD-10-CM diagnosis codes for PAD, which describe the clinical characteristics of CLI/CLTI, including rest pain, ulcers and/or gangrene.
Q: What are the implications for diagnosis of CLI/CLTI?
Lookstein: This is a significant first step to empower patients and their treating physicians to build consensus on how to diagnose and track these patients prospectively. This is also an opportunity to support coding professionals, educators, and compliance staff to report CLI/CLTI consistently in order to track and monitor patient treatments and outcomes in the future.
Q: What are the implications for treatment of CLI/CLTI?
Lookstein: With better means to track and report the patient diagnoses, treatment options and outcomes, we as a clinical community of vascular specialists aim to improve our ability to provide better care and greater access to care for patients, so we can prevent the debilitating losses of limbs and loss of lives to this disease.
Q: What are the implications for paperwork/reimbursement?
Lookstein: By linking the terms CLI/CLTI with the specific diagnoses already within the ICD-10-CM code set, we aim to improve the consistency and accuracy of the diagnostic methodology as we study future outcomes for these patients and the specific resources that are used to achieve the best outcomes. This may, in fact, lead to our ability to better demonstrate that specific resources such as multispecialty teams are required to achieve optimal outcomes for this extremely high-risk population.
Q: Is there anything else you would like to mention?
Lookstein: The CLI Global Society is committed to continue our ongoing collaboration with all the vascular specialist societies to ensure that we can all improve outcomes for patients suffering from CLI by saving their limbs and their lives. We had technical assistance with the proposal process from health policy/market access adviser Adi Renbaum of ANR Consulting LLC, and Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, COC, of Clarity Coding, a professional coder.
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Photo courtesy of: Healio
Originally Published On: Healio
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