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Gastroschisis and omphalocele codes “all-inclusive”: urgent need for modifications!
966 [9] Golladay ES, Tepas JJ, Pickard LR, et al. Bacteremia after esophageal dilation: a clinical and experimental study. Ann Thorac Surg 1980;30: 19-23. [10] Appignani A, Trizzino V. A case of brain abscess as complication of esophageal dilation for caustic stenosis. Eur J Pediatr Surg 1997;7: 42-3. [11] Schlitt M, Mitchem L, Zorn G, et al. Brain abscess after esophageal dilation for caustic stricture: report of three cases. Neurosurgery 1985;17:947-51. [12] Lui TN, Lee ST, Chang CN, et al. Brain abscess after dilatation of esophageal stricture. Pediatr Neurosci 1988;14:250-3. [13] Neuman A, Lernau OZ, Goldberg M, et al. Brain abscess: a complication of oesophageal dilatations. Z Kinderchir 1986;41:43-4. [14] Djupesland P, Solgaard T, Mair IW. Cerebral abscess complicating dilatation of a corrosive esophageal stricture. Eur Arch Otorhinolaryngol 1991;248:308-10. [15] Ersahin Y, Mutluer S, Cakir Y. Multiple brain abscesses following esophageal dilation. Childs Nerv Syst 1995;11:351-3. [16] Harp DL, Schlitt M, Williams JP, et al. Brain abscess following dilatation of esophageal stricture. Clin Imaging 1989;13:140-1. [17] Bautista-Casasnovas A, Castro-Gago M. Multiple brain abscesses following esophageal dilation. Childs Nerv Syst 1996;12:1. [18] Murray PR, Baron EJ, Pfaller MA, et al, editors. Manual of clinical microbiology. 7th ed. ASM Press; 1999, pp283-284, p605. [19] Wessels MR. Streptococcal and enterococcal infections. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, editors. Harrison's principles of internal medicine. 14th ed. McGraw Hill; 1998. p. 885-92. [20] Standards of Practice Committee, Egan JV, Baron TH, Adler DG, et al. Esophageal dilation. Gastrointest Endosc 2006;63:755-60. [21] Hirota WK, Wortmann GW, Maydonovitch CL, et al. The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial. Gastrointest Endosc 1999;50:475-9.
Gastroschisis and omphalocele codes all-inclusive: urgent need for modifications!
To the Editor, Because of growing concern for increasing prevalence of gastroschisis nationally and internationally, there is a need for close epidemiologic monitoring of this defect. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes [1] used by databases in hospitals for their coding system are helpful for case ascertainment in large studies. However, gastroschisis and omphalocele, 2 separate and clinically very different abdominal wall defects (AWD), have the same ICD-9-CM code, 756.79. Further complicating the issue is that the ICD-9 code, 756.7, used by Collins et al in the study from Tennessee [2] is an “allinclusive” code for anomalies of abdominal wall and not specific to gastroschisis and omphalocele. Also, it is not a complete code by itself and requires an additional fifth digit as follows: 756.70 (Anomaly of abdominal wall, unspecified), 756.71 (Prune-belly syndrome, Eagle-Barrett syndrome, Prolapse of bladder mucosa), and 756.79 (Other congenital anomalies of abdominal wall—Exomphalos, Omphalocele, Gastroschisis. Excludes umbilical hernia [551-553 with .1]). Using this nonspecific code in the analysis, therefore, carries
Correspondence the risk of including other congenital abdominal wall anomalies (such as Prune-belly syndrome, anomalous body wall complexes/body stalk anomaly, ectopia cordis, bladder extrophy, and others) leading to overestimation of the 2 defects. The etiology of the rising prevalence of AWD remains unknown; however, further differentiation of the various defects contributing to the rise would be valuable. Some studies have reported a recent stable or decreasing prevalence of omphalocele, thus, altering the ratio of omphalocele to gastroschisis from 3:2 in the past to 1:1 [3]. In the interest of studies evaluating this further, it is imperative to provide investigators with a method to identify and track the 2 defects with separate codes, thus, enabling accurate case ascertainment. Hence, there is an urgent need for clarification of the current coding system with clinical modifications to the ICD-9 codes so as to help differentiate these distinct abdominal wall defects [4]. A suggested method of requesting modifications to the codes is to submit a code change proposal to the ICD-9-CM coordination and maintenance committee [5] which is a federal committee created as a forum for proposals to update ICD-9-CM. It is cochaired by a representative from the 2 agencies sharing the responsibility of maintenance of the ICD-9-CM—National Center for Health Statistics, which is responsible for the classification and diagnosis (volumes 1 and 2) and Centers for Medicare and Medicaid Services, which is responsible for procedures (volume 3). The instructions for requesting revisions to the ICD-9-CM codes can be reviewed [6], and the proposal should include a description of the code being requested along with rationale for the change and evidence supporting the need for the new code and be sent to the office of National Center for Health Statistics [7]. Shilpi Chabra Department of Pediatrics University of Washington Box 356320, Seattle, WA 98195, USA E-mail address: [email protected] doi:10.1016/j.jpedsurg.2008.01.003
References [1] Ingenix ICD-9-CM expert for physicians, Volumes 1 & 2, 2007: 235-6. [2] Collins SR, Griffin MR, Arbogast PG, et al. The rising prevalence of gastroschisis and omphalocele in Tennessee. J Pediatr Surg 2007;42:1221-4. [3] Hwang PJ, Kousseff BG. Omphalocele and gastroschisis: an 18-year review study. Genet Med 2004;6(4):232-6. [4] Chabra S, Gleason CA. Gastroschisis: embryology, pathogenesis, epidemiology. NeoReviews 2005;6:e493-9. [5] http://www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm. [6] http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/02_newrevisedcodes.asp#TopOfPage. [7] http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/Downloads/ request_codes.pdf.
Gastroschisis and omphalocele codes all-inclusive: urgent need for modifications!
To the Editor, Because of growing concern for increasing prevalence of gastroschisis nationally and internationally, there is a need for close epidemiologic monitoring of this defect. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes [1] used by databases in hospitals for their coding system are helpful for case ascertainment in large studies. However, gastroschisis and omphalocele, 2 separate and clinically very different abdominal wall defects (AWD), have the same ICD-9-CM code, 756.79. Further complicating the issue is that the ICD-9 code, 756.7, used by Collins et al in the study from Tennessee [2] is an “allinclusive” code for anomalies of abdominal wall and not specific to gastroschisis and omphalocele. Also, it is not a complete code by itself and requires an additional fifth digit as follows: 756.70 (Anomaly of abdominal wall, unspecified), 756.71 (Prune-belly syndrome, Eagle-Barrett syndrome, Prolapse of bladder mucosa), and 756.79 (Other congenital anomalies of abdominal wall—Exomphalos, Omphalocele, Gastroschisis. Excludes umbilical hernia [551-553 with .1]). Using this nonspecific code in the analysis, therefore, carries
Correspondence the risk of including other congenital abdominal wall anomalies (such as Prune-belly syndrome, anomalous body wall complexes/body stalk anomaly, ectopia cordis, bladder extrophy, and others) leading to overestimation of the 2 defects. The etiology of the rising prevalence of AWD remains unknown; however, further differentiation of the various defects contributing to the rise would be valuable. Some studies have reported a recent stable or decreasing prevalence of omphalocele, thus, altering the ratio of omphalocele to gastroschisis from 3:2 in the past to 1:1 [3]. In the interest of studies evaluating this further, it is imperative to provide investigators with a method to identify and track the 2 defects with separate codes, thus, enabling accurate case ascertainment. Hence, there is an urgent need for clarification of the current coding system with clinical modifications to the ICD-9 codes so as to help differentiate these distinct abdominal wall defects [4]. A suggested method of requesting modifications to the codes is to submit a code change proposal to the ICD-9-CM coordination and maintenance committee [5] which is a federal committee created as a forum for proposals to update ICD-9-CM. It is cochaired by a representative from the 2 agencies sharing the responsibility of maintenance of the ICD-9-CM—National Center for Health Statistics, which is responsible for the classification and diagnosis (volumes 1 and 2) and Centers for Medicare and Medicaid Services, which is responsible for procedures (volume 3). The instructions for requesting revisions to the ICD-9-CM codes can be reviewed [6], and the proposal should include a description of the code being requested along with rationale for the change and evidence supporting the need for the new code and be sent to the office of National Center for Health Statistics [7]. Shilpi Chabra Department of Pediatrics University of Washington Box 356320, Seattle, WA 98195, USA E-mail address: [email protected] doi:10.1016/j.jpedsurg.2008.01.003
References [1] Ingenix ICD-9-CM expert for physicians, Volumes 1 & 2, 2007: 235-6. [2] Collins SR, Griffin MR, Arbogast PG, et al. The rising prevalence of gastroschisis and omphalocele in Tennessee. J Pediatr Surg 2007;42:1221-4. [3] Hwang PJ, Kousseff BG. Omphalocele and gastroschisis: an 18-year review study. Genet Med 2004;6(4):232-6. [4] Chabra S, Gleason CA. Gastroschisis: embryology, pathogenesis, epidemiology. NeoReviews 2005;6:e493-9. [5] http://www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm. [6] http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/02_newrevisedcodes.asp#TopOfPage. [7] http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/Downloads/ request_codes.pdf.