Asthma and Patient Engagement: An ICD-10 Marriage

Few relationships in health care equal or trump the intimacy between a health condition and patient engagement than that which will apply to asthma in the wake of the ICD-10-CM transition. The primary reasons are the following:

• The impending ICD-10-CM coding system coincides with the current international asthma classification system - a system devised by an expert panel of the National Heart Lung and Blood Institute (NHLBI) in 2007.
• The new coding system takes into account the meaningful involvement of patients in the treatment of their asthma.

The current ICD-9 diagnosis coding system has three main codes for asthma based on whether or not the asthma is allergic, nonallergic or a mixture of asthma and COPD. The new coding system will be totally different though. Its codes will focus primarily on the frequency and severity of asthma symptoms.

The current asthma classification system rates symptom frequency as intermittent or persistent. Intermittent means that symptoms occur two or fewer days per week. Persistent has three subcategories. They are mild, moderate and severe. Mild means symptoms occur greater than two days per week. Moderate means they occur daily. Severe means they occur throughout the day.

The classification system grades symptom severity based on the following:

• The number of times per week symptoms cause awakening at nighttime
• The number of times per day a short acting inhaler (rescue medication) has to be used to relieve symptoms
• The degree to which symptoms interfere with normal activities of daily living

The current asthma classification system also uses some other variables to classify the disease. But the frequency and severity criteria make it a suitable companion of the ICD -10-CM coding system whose main codes for asthma signify:

• Mild intermittent asthma
• Mild persistent asthma
• Moderate persistent asthma
• Severe persistent asthma

The patient engagement which brings about the asthma/ICD-10-CM marriage is involvement of patients in their disease management in ways that help health care providers choose the most appropriate ICD-10-CM codes pertaining to their health care. The lion's share of that involvement will be patient record-keeping. Much of the record-keeping should pertain to the frequency and severity of symptoms as well as some of the other criteria utilized by the international classification system.

One such criterion is lung function. The volume of air expelled with a maximal effort following a maximal deep breath (forced vital capacity or FVC) and the volume of air expelled in one second with maximal effort following a maximal deep breath (forced expiratory volume in one second or FEV1) are the measurements used in classifying asthma based on lung function. A professional performs these measurements in a laboratory setting. Therefore it is not a patient engagement activity. But there is an alternative lung function measurement which patients can perform with a handheld device at home. As such, it is a patient engagement activity. The measurement is peak flow rate, which is the maximum speed at which a person can exhale air after taking the deepest breath possible. The device which performs the measurement is a peak flow meter.

Measurement of peak flow rates is not an official part of the asthma classification system but the system implies that it is an alternative. Additionally, many health care providers are of the same opinion. At any rate, it is a patient engagement activity which can help anchor the marriage between asthma and ICD-10-CM.

Sharing recorded asthma symptom and lung function information with your health care provider will not only promote a happy ICD-10-CM marriage. It can serve as an impetus for a healthier asthma patient.