Web Exclusives - ICD-10 Update
Chase Doyle

Attended by a plurality of the membership, the 12th annual meeting of the Tennessee Rheumatology Society (TRS) fulfilled the society’s stated mission of increasing and propagating the understanding of rheumatic diseases among physicians engaged in the ongoing practice of rheumatology.

“What made the meeting memorable,” said the president of TRS, Satish Odhav, MD, “was not only the quality of the presentations but also the tremendous mix of interactive educational sessions for both clinician and academia.”

ICD-10 Coding

Amiel Tokayer, MD, a rheumatologist from West Palm Beach, Florida, began the meeting Friday evening with a presentation on the coming mandatory ICD-10 coding.

“ICD-10 coding is a source of much trepidation to physicians,” said Tokayer, “particularly to rheumatologists, who often treat multiple complex problems on the same patient in a single office visit.”

According to Tokayer, rheumatoid arthritis must be specified as either RF positive or RF negative; gout must be specified as chronic, acute, with/without tophi; rheumatoid arthritis or connective tissue disorders must be further specified to include any major organ involvement; and drug-induced conditions must include an additional code that represents the drug itself.

Ultimately, Tokayer was able to “de-code and de-mystify” the ICD-10, demonstrating how a 1-page tool can allow for multiple ICD-10 diagnostic codes in a simple but effective way.

Autoimmune Diseases

Yehuda Shoenfeld, MD, director of the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, offered the audience 2 intellectually stimulating presentations. His first talk focused on the interactions between the human immune system and surrounding pathogens—or lack thereof—and how these fit in the mosaic of autoimmunity.

Shoenfeld’s second, more provocative presentation dealt with the recognition of a new autoimmune syndrome dubbed ASIA, or autoimmune inflammatory syndrome induced by adjuvants. This syndrome includes 4 enigmatic conditions affecting genetically predisposed individuals exposed to various factors that chronically stimulate the immune system.

Ruth Ann Vleugels, MD, MPH, from Harvard Medical School, also offered 2 presentations. First, she provided practical clinical pearls for the diagnosis and advanced management of cutaneous lupus erythematosus. In her second presentation, Vleugels described the dermatologic manifestations of dermatomyositis, systemic sclerosis, and other fibrosing disorders.

John M. Stuart, MD, from the University of Tennessee Health Science Center in Memphis, presented research into a common joint condition, namely osteoarthritis. Stuart described a means of detecting very early cartilage degradation and the potential to quantify these changes in real time using nondestructive procedures. He also described a novel delivery system for targeting cartilage or even specific cells within the tissue—a system that would allow for controlled release of therapeutic agents at the site of cartilage damage.

Finally, Linda Kay Myers, MD, a colleague of Stuart at the University of Tennessee, shared with the membership the results of years of research. With long-term interest in the pathogenesis of juvenile rheumatoid arthritis, most of Myers’ research has centered on the hypothesis that an autoimmune response to a cartilage-specific protein (mainly type II collagen) contributes to the inflammation and destruction of cartilage in that medical condition.

“If this hypothesis is true,” concluded Myers, “then oral administration of type II collagen may lead to T-cell tolerance and hopefully suppression of disease.”

Attendees also appreciated presentations by 2 fellows, Syed Islam, MD, from the University of Tennessee program, and Ami Joglekar, MD, from the Vanderbilt program, who described 2 interesting clinical cases, with a review of the relevant literature.

The Future of TRS

The 12th annual meeting was funded by several corporate sponsors and vendors. The Tennessee Chapter of the Arthritis Foundation and the Lupus Foundation were both given the opportunity to highlight activities of their respective foundations.

“Thirteen years ago,” said Odhav, current TRS president, “the founding president envisioned the creation of an encompassing statewide rheumatology society. This and other meetings were definitive proof that their initial vision bore fruit.”

Looking toward the future, however, Odhav saw the potential for even greater influence. “The TRS modus operandi could be emulated by other rheumatology state societies in which relations between clinicians and academicians are less than stellar,” he suggested.

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Last modified: March 7, 2019
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