(043) INACCURATE AND INADEQUATE ICD-10 CODING RELATED TO FEMALE SEXUAL HEALTH THREATENS PATIENT CARE, RESEARCH AND BILLING
Authors: Van Dorn C , Haering C , Ayele A , Krapf J , Pope R 
Published: June 2024

Abstract

Introduction
The International Classification of Diseases (ICD) is an international health information system for the collection, processing, classification, and presentation of mortality statistics. The ICD 10th Edition (ICD-10) is a tool for physicians and billing professionals to accurately bill for the care provided. However, physicians who treat female sexual health (FSH) disorders report difficulty in finding appropriate codes for diagnoses and clinical syndromes (Parish et al. 2021). These issues impede the process for appropriate treatment and allotting the correct reimbursement to providers. Additionally, quantitative and qualitative research on FSH is limited due to the lack of accurate ICD codes for FSH disorders in this cohort.

Objective
This study aims to evaluate the ICD-10 coding system to assess the accuracy and quality of codes related to common FSH disorders.

Methods
A list of 50 most commonly encountered clinical FSH diagnoses was created based on clinical practice findings and ISSWSH guidelines. The list was compared against existing ICD-10 codes to characterize current FSH disorders that are recognized in ICD-10 and determine which FSH disorders are billable (ICD10data.com categorizes codes as “billable” or “non-billable”) or missing entirely. FSH diagnoses explicitly listed as an independent diagnosis or generally listed were considered ICD-10 coded. Diagnoses were considered to not have an existing code if they were not explicitly listed independently or under a more general term.

Results
44% (n=22) of the diagnoses did not have existing ICD-10 codes, and 6% (n=3) of the diagnoses had appropriate ICD-10 codes but were not billable (Figure 1, Table 1). FSH diagnoses such as “clitoral adhesions”, “clitorodynia” and “persistent genital arousal disorder” were not coded in ICD-10. Many diagnoses were grouped under general terms - pelvic floor pain disorders were grouped under “R10.2: Pelvic and peroneal pain” which included both male and female diagnoses. Other codes had significant diagnostic overlap - “vulvodynia” was separately cataloged as “N94.810: vulvar vestibulitis”, “N94.818: Other vulvodynia” and “N94.819: vulvodynia, unspecified”. There were numerous common FSH diagnoses with incomplete, inaccurate, or outdated ICD codes.

Conclusions
These findings highlight the pressing need for an expanded, comprehensive, and precise set of ICD codes dedicated to FSH disorders. Without appropriate coding for 50% of FSH diagnoses, clinical care, research, and healthcare billing are severely impeded. It is much more difficult for physicians to accurately classify and bill for their procedures, which may create problems with clinical documentation leading to delayed treatment and poor clinical outcomes. For example, existing codes for “vulvodynia,” a common disorder affecting 16% of women, are vague and unclear, which lacks practicality for charting and billing purposes. Additionally, the limitations of ICD coding make it nearly impossible to research specific disorders, as they can not be searched in databases like TriNetX. These limitations may explain the large gaps in the literature regarding FSH disorders. Additionally, electronic medical records often have outdated ICD codes, further creating obstacles for clinicians. The current gap in classification, including ICD-10 coding and medical records, must be addressed to advance the understanding and management of FSH disorders.

Disclosure
No.