On Sept. 12, the ACR and the Sjögren’s Syndrome Foundation presented an ICD-10 code change request for Sjögren’s syndrome to the ICD-10 Coordination and Maintenance Committee (C&M) at the CMS office in Baltimore. The request is intended to clarify ICD-10 M35.0: sicca syndrome [Sjögren].
Why Change the Code?
The rationale behind this significant change request the current ICD-10 code is that the current code, M35.0, does not contribute to the most accurate coding information and knowledge base of Sjögrens; rather, it creates confusion and contributes to difficulty with insurance reimbursement. The existing code is misleading for providers and coders because it appears that sicca syndrome was intended to reflect Sjögren’s disease. However, Sjögren’s is not defined by sicca in any sense or use of the word. The classification criteria for Sjögren’s have never used the term sicca syndrome or even the word sicca. The criteria form the basis for making this request for a major update to the clinical modification.
Committee Make-Up & Final Decision
The ICD-10 C&M is a federal committee that includes representatives of the CMS and the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. It is responsible for approving code changes, diagnosis errata, addenda and modifications to the International Classification of Diseases.
The change proposal was accepted by the CDC, and the final decision on the code revision will be made through the clearance process within the Department of Health and Human Services. If approved, the revision would go into effect in 2019.