The International Classification of Diseases saw its first edition in 1893 when physicians and other medical professionals sought to organize and classify every disease known in the world at that time. “Transsexualism” was included in previous versions, but it must now be noted that the term is currently deemed out of date by the World Health Organization as well as offensive, making the term no longer applicable. The current terms are “gender incongruence,” which is the state of identifying as a gender other than what someone received at birth, and “gender dysphoria,” which is the state of unease that arises when others react poorly in one way or another to the person experiencing gender incongruence.
What Are ICD-10 Codes?
In ICD-10, the 10 stands for the 10th revision of the original document. Currently, ICD-11 has been rolled out, but acceptance around the world won’t likely be complete until 2025, or even later, which leaves ICD-10 as the de facto version of the ICD.
The list contains a code for each disease, and within the realm of each code, there will, most of the time, also be subcategories for different variants of the diseases. The list also contains expanded notes and descriptions of treatment options, symptoms and signs, different prognoses, and other numbers regarding each condition.
The goal in 1893, as now, was to keep track of diseases and note their spread, effects, and lethality if applicable. Fighting the spread of diseases is central to the administration of public health. We saw that firsthand during the COVID-19 pandemic. The way other diseases affect people gives researchers needed information when devising methods for combating those diseases. Mutations happen, too, as with COVID-19, so a thorough understanding of previous strains of a disease allows medical professionals to deal more effectively with new strains than before.
When new treatments arise, medical professionals need to know that they’re safe and effective. The ICD-10 list is a repository for that kind of information, which also includes a listing of unpleasant side effects of both each disease and each of the applicable treatments.
Comorbid conditions, which exist on the ICD-10 list within subcategories that are also cross-referenced between different primary diseases, must also be tracked. Each condition might require its own treatment, and one treatment might be contraindicated with a comorbid condition. In these cases, the medical professionals would have to pick a different primary treatment method.
The last thing that makes the ICD-10 list useful is that it helps with billing and coverage when it comes to health insurance. The American health insurance system is a veritable Gordian knot, and billing issues can affect coverage, which is detrimental to people’s health. The ICD-10 list enables health insurance companies to bill correctly so that people get the coverage for which they pay. Also, the companies can track trends, make predictions, and plan for the future.
ICD-10 Code F64.0: Gender Dysphoria
ICD-11 includes changes around gender dysphoria and gender incongruence. For example, the term gender identity disorder no longer applies. The current correct term is gender dysphoria. It must also be noted that gender incongruence, which is a person’s experience of not being the sex assigned at birth, largely because of unwarranted pressure to conform to the social construct of gender needing to match the assigned sex at birth, is not a disease of any kind.
Rather, the condition known as gender dysphoria, which is the sense of discomfort, anxiety, and unease that comes about when societal pressures to conform to one’s birth gender causes undue stress, is generally, but not universally, classified as a disorder because this stress can lead to depressive disorder, self-harm, and even suicidal ideation. As the Merck Manual notes, this re-classification is in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which is otherwise known as DSM-5.
Unlike many primary codes, code F64.0 is a billable code on the ICD-10 and ICD-11 lists. It should be noted here that this code being billable only applies to the American form of the list and that the entry on international versions of the list might be different. The code applies to gender dysphoria in adolescents and adults but not children. The code F64.2 is for gender incongruence in children, and it is also a billable code.
The entire F64 series of codes is no longer considered a subcategory of “other mental disorder diagnoses.” The World Health Organization insisted on these changes, largely because of the tremendous stigma involved. The link referenced in the previous sentence contains the applicable text: “Gender incongruence has been moved out of the ‘Mental and behavioral(sic) disorders’ chapter and into the new ‘Conditions related to sexual health’ chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.”
Gender Dysphoria Itself
Currently, research indicates a lack of sufficient data to determine the exact number of cases of gender dysphoria as related to gender incongruence. Still, as shown in the Merck Manual link highlighted above, survey-based studies show that between 0.1% and 0.2% of people experience gender dysphoria to some degree. Between four and five times that number of people identify as transgender. An equal number of people indicated that they were gender incongruent in some fashion other than being transgender. When considering children, the numbers are far higher, roughly eight to 10 times more prevalent than with adults.
DSM-5 lists three separate subcategories of gender dysphoria: children, adolescents, and adults. Generally, for someone’s gender incongruence to include gender dysphoria, the person must experience certain signs and symptoms for at least six months.
Again, it is interesting to note that many experts in the field don’t even consider gender dysphoria to be a mental-health condition at all. Rather, they consider it a general condition. Additionally, these same experts applaud the decision to move both gender incongruence and gender dysphoria to a new classification in the ICD-11 list, namely that of sexual health. Further, a distinct subgroup of these experts doesn’t even consider gender incongruence and gender dysphoria to be conditions at all. Instead, they maintain that both of these are simple expressions of human gender identity.
One point where all of the experts agree is that people who experience gender incongruence, gender dysphoria, or both, are far more susceptible to an increased burden when it comes to mental health and sexual health diagnoses. Chiefly, this burden arises when both society and the medical field as a whole erect walls that prevent these people from receiving the care they need.
The origin and/or etiology of these conditions is not completely understood. Genetics, hormones, and postnatal environment are all thought to be contributing factors of one strength or another. The field of study lacks data, however. For example, one group of studies found correlation between monozygotic twins experiencing gender incongruence more often than dizygotic twins while another group of studies did not find the same degree of correlation.
The signs of gender incongruence and/or gender dysphoria are usually clear. However, parents and guardians often ignore such signs or label them “a phase,” which can exacerbate the feelings of dysphoria in children who wouldn’t experience such feelings were their incongruence recognized and supported.
Remember, a person must exhibit the incongruence for at least six uninterrupted months. Some of the signs of children experiencing one or both of these conditions include:
- Insisting that they are a gender other than that which they were assigned at birth
- Preferring to dress as another gender
- Stating that they wish they’d wake up as another gender
- Intensely disliking the physical characteristics of the gender that they were assigned at birth
- Preferring playmates of another gender and/or activities that are routinely associated with another gender
Currently, there is no extant research that can state when gender incongruence or gender dysphoria begins even with just a small degree of correlation. Therefore, there is extensive controversy over when children “should be believed” regarding their gender. According to the Merck Manual, intense research is ongoing, which is encouraging. The World Professional Association for Transgender Health recommends that parents and the relevant medical professionals provide supportive care to children who experience these conditions
Adults sometimes either disregard their incongruence or dysphoria or bury it inside themselves to avoid the stigma. For example, people who are assigned male at birth, or AMAB, exhibit “hypermasculinity” to seem “normal” rather than show that they are trans women. People who are assigned female at birth, or AFAB, could do the same with “hyperfemininity” rather than show that they are trans men.
When it comes to treatment of these conditions, trying to change the person’s feelings is seen as both harmful and unethical. In other words, people are who they are no matter what “the plumbing” says. Gender-affirming care is the only treatment for the incongruence. When it comes to the mental health angle, what should be treated are the conditions that arise when trans people experience bullying, hate, threats, and even violent physical attacks.
Depressive disorder is common in trans people. About a third of trans people experience clinically diagnosed depressive disorder. Compare that with 4.4% of the general worldwide population. Levels of general anxiety about the stigma, hate, and violence are roughly the same as those regarding depressive disorder, meaning that a little less than two-thirds of trans people in the world experience some form of mental health condition that stems from society’s treatment of them.
Why Accuracy Is Important
Accuracy is an integral part of clients receiving the right care that they need. Both the ICD-10 list and the upcoming ICD-11 list contain the right codes for proper billing and claim processing. When it comes to gender incongruence and gender dysphoria, it’s obvious that ICD-11 is much more relevant than ICD-10.
Medical professionals have already begun using the terminology in ICD-11 in the United States. Therefore, to maintain agreement between the medical profession and the insurance industry, insurance companies will have to follow suit. Both fields can contribute to reducing the stigma attached to people experiencing gender incongruence, gender dysphoria, or both by making the transition to and supporting the new terminology in ICD-11.
To maintain equanimity in the quality of care across the board, trans people need to have the same access to and coverage for the requisite mental healthcare and gender-affirming care when they need it. It is incumbent upon the insurance industry to rise to the occasion.
How AutoNotes Can Help
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