Today is Veterans Day, so first I would like to thank those who have served or are currently serving in the military for their service to our country.
With our past Inpatient Prospective Payment System (IPPS) Final Rule update, effective on Oct. 1, we got a new code for Gulf War Illness: Code T75.830-, with 7th characters A, D, or S to identify for the episode of care. There is also a “use additional code” note instructing us to assign an additional code to identify any associated manifestations. Code T75.838 would be assigned for Effects of other war theater, making the distinction between the Gulf War and other conflicts.
Veterans for Common Sense published a concise Q&A on this new Gulf War Illness code that offers some good background information. It emphasized that having this code allows providers and those doing research a way to identify those veterans suffering from Gulf War Illness, both inside and outside of the Veterans Affairs (VA) system. The Q&A also noted that the addition of the new code validated Gulf War Illness as a medical disorder, pointing out that prior to the new code adoption, Gulf War veterans were often told “there is no such thing.”
As coders, we know the importance of ICD-10-CM codes. The Q&A document notes that not only does this new code provide a means of diagnosis, it also allows for tracking those with the illness (including any other conditions that occur with the syndrome), as well as monitoring the effectiveness of potential and tried treatments. The lack of a specific code, it notes, compromised care for those veterans who displayed signs and symptoms, since there was no diagnostic label that could be assigned.
As coders, we also have an idea of how new codes are requested. In this case, a consortium composed of researchers and a Gulf War veteran advocate prepared and presented a request to the Centers for Disease Control and Prevention’s (CDC’s) ICD-10 Coordination and Maintenance Committee in 2023. As part of that request, the consortium presented a diagnostic criteria statement for consideration. The criteria noted that “this health condition requires deployment to the Gulf War Theater of Operations anytime between August 1, 1990, and July 31, 1991. It requires chronic symptoms for ≥ 6 months, arising during or after this deployment, in ≥ 3 of the 6 Kansas (case definition) criteria questionnaire symptom domains of fatigue/sleep; neurological/cognitive/mood; pain; gastrointestinal; respiratory; and dermatologic. For a domain to qualify for this condition, symptoms in the domain must be either of at least moderate severity (not mild) and/or there must be multiple symptoms in that domain.”
The Gulf War area, for VA disability claim purposes, is defined as a region labeled Southwest Asia. Countries involved include Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates (UAE), Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. The Q&A document also identifies additional Southwest Asia locations that have been associated with undiagnosed illness and Medically Unexplained Chronic Multi-symptom Illness (MUCMI). These include Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan.
As of Oct. 1, we also have new external cause codes with military implications; Y36.A- and Y37.A- describe both high-level and low-level blast overpressure in war operations or military operations, respectively. These codes allow assignment of the external cause of injuries sustained both at war and during peacetime, occurring in routine military exercises and operations.
Again, we salute those who have served or continue to serve in our armed forces.
Christine Geiger, MA, RHIA, CCS, CRC, is Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, Inc.℠, a healthcare consulting firm based in St. Louis. First Class Solutions, Inc.℠ assists healthcare organizations in enhancing or transforming their health information management (HIM) operations, facility and physician office documentation, and revenue cycle performance, and provides coding support and coding audits.
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