ICD-10-CM Codes Debut for Two Hair Loss Disorders

On October 1, 2024, International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for central centrifugal cicatricial alopecia (CCCA) and frontal fibrosing alopecia (FFA) took effect for the first time, a development characterized as a critical advancement in the field of hair loss disorders.

“CCCA and FFA are conditions that require early diagnosis and intervention to prevent irreversible hair loss,” Maria Hordinsky, MD, professor of dermatology at the University of Minnesota, Minneapolis, and a member of the Board of Directors, Scarring Alopecia Foundation (SAF), said in an interview. “The use of these new codes will make it easier for clinicians to identify affected patients and improve treatment outcomes. It also opens the door for more robust research efforts aimed at understanding the etiology and progression of CCCA and FFA, which could lead to new and more effective treatments in the future. Overall, this development represents a positive step toward improving care for individuals affected by these challenging conditions.”

The new codes — L66.81 for CCCA and L66.12 for FFA — were approved by the Centers for Disease Control and Prevention (CDC) on June 15, 2023, but not implemented until October 1, 2024. 

Amy McMichael, MD, professor of dermatology at Wake Forest University School of Medicine, Winston-Salem, North Carolina, and a scientific advisor to SAF, told Medscape Medical News that Itisha Jefferson, a medical student at Loyola University Chicago’s Stritch School of Medicine, and her peers on the SAF’s Medical Student Executive Board played a pivotal role in advocating for the codes.

In 2022, Jefferson, who has CCCA, and her fellow medical students helped create the proposals that were ultimately submitted to the CDC.

“They were critical in working with the CDC leaders to get the necessary information submitted and processed,” McMichael said. “They were also amazing at corralling our dermatologist group for the development of the necessary presentations and helped to shepherd us to the finish line for all logistic issues.”

On March 8, 2023, McMichael and Hordinsky made their pitch for the codes in person at the CDC’s ICD-10 Coordination and Maintenance Committee meeting, with McMichael discussing CCCA and Hordinsky discussing FFA.

“We also discussed the lack of standardized tracking, which has contributed to misdiagnoses and inadequate treatment options,” Hordinsky recalled. “We highlighted the importance of having distinct codes for these conditions to improve clinical outcomes, ensure that patients have access to appropriate care, better tracking of disease prevalence, and greater epidemiologic monitoring with access to electronic medical records and other large real-world evidence datasets and databases, the results of which could contribute to health policy decision-making.”

To spread the word about the new codes, McMichael, Hordinsky, and other members of the SAF are working with the original team of medical students, some of whom who are now dermatology residents, to develop an information guide to send to societies and organizations that were supportive of the codes. A publication in the dermatology literature is also planned.

For her part, Jefferson said that she will continue to advocate for patients with scarring alopecia as a medical student and when she becomes a physician. “I hope in the near future we will see an externally led FDA Patient-Focused Drug Development (PFDD) meeting for both CCCA and FFA, further advancing care and research for these conditions,” she said in an interview.

McMichael, Hordinsky, and Jefferson had no relevant disclosures to report.