Implementer report: ICD-10 code F44.5 review for functional seizure disorder.

OBJECTIVE: The study aimed to measure the validity of International Classification of Diseases, 10th Edition (ICD-10) code F44.5 for functional seizure disorder (FSD) in the Veterans Affairs Connecticut Healthcare System electronic health record (VA EHR). METHODS: The study used an informatics search tool, a natural language processing algorithm and a chart review to validate FSD coding. RESULTS: The positive predictive value (PPV) for code F44.5 was calculated to be 44%. DISCUSSION: ICD-10 introduced a specific code for FSD to improve coding validity. However, results revealed a meager (44%) PPV for code F44.5. Evaluation of the low diagnostic precision of FSD identified inconsistencies in the ICD-10 and VA EHR systems. CONCLUSION: Information system improvements may increase the precision of diagnostic coding by clinicians. Specifically, the EHR problem list should include commonly used diagnostic codes and an appropriately curated ICD-10 term list for 'seizure disorder,' and a single ICD code for FSD should be classified under neurology and psychiatry.

Fibrolipoma of the orbit.

Herein we present a retrospective case report of a very rare fibrolipoma originating in the orbit. Lipomas and related variants presenting in the orbit are very rare. Only 2 documented orbital fibrolipomas were noted in our review of literature. A 26-year-old woman presented with a growing mass below the left eyebrow 4 years after suffering facial trauma after being kicked in the face by a horse. CT demonstrated a hypodense nodule adherent to the orbital portion of the left frontal bone that was not encapsulated. An elective left anterior orbitotomy with excisional biopsy was performed, and fibrolipoma was confirmed on histopathologic examination. There was no evidence of tumor after 2-year follow up. The presence of a fibrolipoma in the periosteum of the orbital rim is very rare and might be a result of inflammatory transformation following facial trauma.