At a Sept. 23 meeting, the ICD-10 Coordination and Maintenance Committee heard a proposal to create an additional code for the National Institutes of Health Stroke Scale, a widely used tool for measuring neurologic deficit and a scoring system for stroke intervention.

The ICD-10 Coordination and Maintenance (C&M) Committee is composed of representatives from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and 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 the annual Spring or Fall C&M meetings.

Aisha Liferidge, M.D., a practicing physician and assistant professor of emergency medicine at the George Washington University School of Medicine, provided a presentation at the federal interdepartmental committee meeting which serves as a public forum for discussing proposed changes to ICD-10.

While the NIH Stroke Scale can be cumbersome and quite comprehensive, Liferidge told the committee that it is an extremely important and “well-validated” clinical assessment/data collection tool that “captures initial severity” specifically in acute ischemic stroke patients and serves as a “common language” for information exchanges among healthcare providers. “It measures everything from cognition to orientation to strength to the sensation of a patient,” she said.

Based on a 15-item neurologic examination, the scale helps emergency physicians and neurologists to evaluate the acuity of stroke patients, determine appropriate treatment, and predict patient outcome. According to Liferidge, the NIH Stroke Scale has been shown to be a predictor of both short- and long-term outcome for stroke patients.

“There have been several studies validating the NIH Stroke Scale and most recently there have been additional studies that have shown that the stroke scale assigned to a patient after having a stroke is very closely linked to their morbidity as well as their mortality,” she argued.

The only FDA-approved treatment for ischemic stroke is tissue plasminogen activator (tPA). Nonetheless, Liferidge referenced a recent study that showed that even in the case of patients who didn’t receive Tpa, they also demonstrated increased morbidity and mortality thanks to care givers knowing their NIH Stroke Scale score.

Liferidge proposed the creation of an ICD-10 code for the NIH Stroke Scale that would “allow claims-based reporting by hospitals and would also allow for appropriately risk-adjusted data in terms of stroke outcomes.” She pointed out that CMS is currently using a 30-day stroke outcome measure primarily for mortality and readmissions in the in-patient quality reporting program. However, Liferidge asserts that incorporating an additional code for NIH Stroke Scale would only serve to “strengthen CMS in terms of their position with regard to being able to re-stratify stroke patients” and “would be an enhancement that would make a significant improvement.”

Organizations supporting the inclusion of an ICD-10 code for the NIH Stroke Scale are: the American Stroke Association, American Academy of Neurology, American Association of Neurological Surgeons and Congress of Neurological Diseases, American College of Emergency Physicians, and the American Society for Neuroradiology, among others.  


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