Intelligent Medical Object's additional verbiage


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I'm not quite sure if my question belongs in this thread but here goes.....

I have discussions at time with IMO (Intelligent Medical Objects), the organization that feed the rest of the USA and maybe internationally with SNOMED/ICD-10-CM Codes.

I have been in discussion with them regarding a recent update we received in our EMR. This is their response to my question regarding why they took the liberty of adding "on maintenance therapy" to the F11.21 code:

Hi Donna,

Appreciate all of your feedback here! After thorough review, we have determined that this term’s verbiage and mapping are valid.

I think it’s worth reviewing the criteria by which we create IMO content. When IMO creates a term, our clinicians (here, Dr. Jeff Pierson) ensure that it describes a valid, unambiguous clinical concept. The IMO term “Severe opioid use disorder, in early remission, on maintenance therapy" meets this criteria. Our clinical informatics team maps every IMO term to 1 (or more) SNOMED concept(s).

IMO’s mapping team then assigns code mappings to ICD-10-CM. They have established that the IMO term “severe opioid use disorder, in early remission, on maintenance therapy” is correctly mapped to ICD-10-CM preferred primary code F11.21. This follows ICD-10 index guidance for: Disorder (of), opioid use moderate or severe, in remission (early) (sustained) F11.21. This is where ICD-10 classifies severe opioid use disorder in remission. The additional text “on maintenance therapy” does not change the ICD-10 index path or resulting ICD-10 code. While ICD-10-CM provides guidance on coding, it is not designed to provide an exhaustive list of verbiage found in clinical documentation. (my point exactly as I feel the provider should be documenting this additional information).

The DSM-5 is the definitive source for naming behavioral health disorders, and is thus the authority on phrasing this area of clinical documentation. We all agree that “on maintenance therapy” should be documented by the provider. I think we differ on where to document it. The IMO description is an integral and persistent part of the provider’s documentation, and thus an appropriate place to document this condition.

Please feel free to reach out with comments or concerns.

Plane and simple they have added verbiage to the code F11.21 code and I believe this is to be documented by the provider. We find that verbiage such as this will remain on the problem list long after the patient has been either taken off "maintenance therapy", relapsed, or even worse, and one could argue that providers should be updating their problem list, and I agree also, however, the truth is, they don't have enough time to undo verbiage that they may not have meant to document.

Would appreciate your thoughts.