Changes in ICD-10 for Sjögren’s Syndrome

Sjögren’s syndrome is a systemic autoimmune disease that affects the entire body. In Sjögren’s syndrome, the immune system targets the mucous membranes and moisture secreting glands, leading to decreased moisture throughout the body and resulting in decreased tears and saliva, dry skin, dry vagina and decreased moisture in the esophagus, lungs and digestive tract. Along with symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies and lymphomas.

With the implementation of this revised tabular modification for Sjögren’s syndrome, it is important to review the code changes and begin educating coders, clinical documentation professionals and providers about the changes. Missing pieces are the designations for the final complications and comorbidities, and major comorbidities, which will be published with the Inpatient Prospective Payment System (IPPS) Final Rule for fiscal year 2020 (see Table 1).

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Who Makes Updates to ICD-10 Codes? The ICD-10 C&M Committee is a federal interdepartmental committee comprising representatives from the CMS and the Centers for Disease Control & Prevention’s National Center for Health Statistics. The committee is responsible for approving coding changes, developing errata, addenda and other modifications. Requests for coding changes are submitted to the committee for discussion at either their spring or fall C&M meeting. The meetings are a public forum for the presentation of proposed modifications to the International Classification of Diseases, 10th Revision, Clinical Modification and ICD-10 Procedure Coding System.

The Sjögren’s Syndrome Code Change Advisory Team

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The ICD-10 code change advisory team consisted of an excellent representation from different fields and stakeholders who volunteered their time and expertise and worked tirelessly to accomplish the code changes. Special thanks to Alan Baer, MD, who graciously accepted the role of representing the team at the ICD-10 C&M meeting, and to all the stakeholders who provided excellent input.

The Sjögren’s syndrome team included:

• ACR/CORC: Antanya Chung
• Sjögren’s Syndrome Foundation: Steven Taylor and Kathy Hammitt
• Industry: Jo Annah Jensen (Novartis)
• Presenter: Alan N. Baer, MD (Director, Jerome Greene Sjögren’s Syndrome Clinic & professor of medicine, Johns Hopkins University School of Medicine, Baltimore)
• Additional Rheumatologists: Nancy Carteron, MD (University of California, San Francisco); Theresa Lawrence Ford, MD (Sjögren’s Syndrome Foundation Medical & Scientific Advisory Board chair; CEO & medical director, North Georgia Rheumatology Group, Lawrenceville, Ga.); Frederick Vivino, MD (director, Sjögren’s Syndrome Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia)
• Pediatric Rheumatology: Scott Lieberman, MD (University of Iowa Carver College of Medicine, Iowa City)
• PCP: Judith Furlong, MD (ProMedica Physicians Family Medicine, Toledo, Ohio; Sjögren’s patient)
• Rheumatology & Neurology: Julius Birnbaum, MD (co-director, Jerome Greene Sjögren’s Syndrome Clinic, Johns Hopkins University School of Medicine, Baltimore)
• Pulmonary: Augustine Lee, MD (Mayo Clinic, Jacksonville, Fla.)
• Renal: Marie Hogan, MD (Mayo Clinic, Rochester, Minn.)
• Ophthalmology: Lance Forstot, MD (Corneal Consultants of Colorado, Littleton)
• Oral medicine: Vidya Sankar, MD (Brigham and Women’s Hospital, Boston)
• Oncology: Richard Ambinder, MD, PhD (Johns Hopkins University School of Medicine, Baltimore)
• GI: Katerina Shetler, MD (Palo Alto Medical Foundation, Mountain View, Calif.)

The ACR and Sjögren’s Syndrome Foundation are excited that this key update will bring more specificity to Sjögren’s diagnosis coding. For coding questions and tabular modifications on the ICD-10 update, contact Antanya Chung at [email protected] or [email protected].

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