Underutilization of Syndrome-Specific ICD-10 Codes for Genetic Epilepsies: Implications for Precision Medicine

Objective

Syndrome-specific ICD-10 codes have the global potential to enhance patient identification for precision therapies, clinical trials, and research. However, their real-world uptake remains poorly understood. Thus, this study evaluated the utilization of syndrome-specific ICD-10 codes for monogenic epilepsies at a large academic medical center.

Methods

We queried an institutional genetic testing database to identify patients with pathogenic or likely pathogenic variants in ten epilepsy genes with established syndrome-specific ICD-10 codes (CDKL5, EHMT1, KCNQ2, MECP2, MED13L, SCN1A, SHANK3, SLC13A5, SLC2A1, SYNGAP1 ). Clinical encounters were extracted from the electronic health record (EHR), and patients were included if they had at least one encounter after the later of two dates: the implementation of the syndrome-specific code or the date of their genetic test result. Variants of uncertain significance were manually curated, and phenotypes for Rett and Dravet syndromes were reviewed to ensure accurate grouping.

Results

Of 83 patients with qualifying variants, 39 met all inclusion criteria. Despite confirmed diagnoses, only 22 of 39 (56.4%) patients were ever documented with a syndrome-specific ICD-10 code. Additionally, these codes were only utilized in 31.1% of all encounters and represented just 14.5% (235/1,626) of codes used. Uptake varied by syndrome, provider specialty, and encounter type, and increased over time. In the Dravet syndrome subgroup (N=23), generic epilepsy codes were documented in more than twice as many encounters as the Dravet-specific code (G40.83). When G40.83 was documented, other epilepsy codes were utilized less frequently, suggesting that clinicians may treat G40.83 as a substitute for broader epilepsy ICD-10 codes.

Significance

Syndrome-specific ICD-10 codes for monogenic epilepsies are underutilized and inconsistently applied, limiting their ability to support precision medicine, and research. Automated and patient-driven coding support, as well as integration of structured genetic data in the EHR, are needed to close the gap between code availability and clinical practice.

Key Points

• Syndrome-specific ICD-10 codes for monogenic epilepsies are available but remain underutilized in clinical practice.

• Fewer than two-thirds of patients with molecular diagnoses were ever assigned their syndrome-specific ICD-10 code, and usage was inconsistent across encounters.

• Documentation of syndrome-specific ICD-10 codes varied by syndrome, provider specialty, and encounter type.

• In Dravet syndrome, generic epilepsy codes were documented more than twice as often as the Dravet-specific code (G40.83). When G40.83 was utilized, other epilepsy codes were documented less frequently.

• Underutilization of syndrome-specific codes may limit patient identification for precision therapies, clinical trials, and rare disease research.