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Changes in classifications of chronic lower-limb wound codes in patients with diabetes: ICD-9-CM versus ICD-10-CM
Jeanne R Lowe1, Greg Raugi, Gayle E Reiber
1Jeanne R. Lowe, PhD, RN • Affiliate Assistant Professor • University of Washington School of Nursing • Manager • Pay-for-Performance, Finance Department • UW Medical Health System • Seattle, Washington Greg Raugi, MD, PhD • Chief, Teledermatology • VA Puget Sound Medical, Center • Seattle, Washington Gayle E. Reiber, PhD, MPH • Senior VA Career Scientist • VA Puget Sound Health Care System • Seattle, Washington JoAnne D. Whitney, PhD, RN, CWCN, FAAN • Professor • Biobehavioral Nursing and Health Systems • University of Washington School of Nursing • Seattle, Washington.
Purpose:
To enhance the learner's competence with knowledge of changes in classifications of chronic lower limb wound codes from ICD-9-CM to ICD-10-CM in patients with diabetes.
Target Audience:
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
Objectives:
After participating in this educational activity, the participant should be better able to:1. Identify the upcoming transition date and coding differences of ICD-9-CM and ICD-10-CM coding.2. Interpret the author's study population, methods, and design.3. Summarize the author's study findings comparing ICD-9-CM coding to ICD-10-CM coding.
Objective:
To determine the sensitivity and specificity of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) and ICD-10-CM codes for individuals with diabetes and foot ulcers.
Design And Methods:
Wound care providers and researchers are concerned about the potential impacts when the United States transitions from ICD-9-CM to ICD-10-CM. To identify the impact on diabetic foot ulcers, health history and wound variables were prospectively assessed with criterion-standard data from a prospective study of 49 patients with 65 foot ulcer episodes representing 81 incident foot ulcers. The ICD-9-CM and ICD-10-CM code sets were mapped to correctly classify individuals with diabetes and foot ulcers.
Results:
Frequencies for health history variables were similar in both systems. The ICD-9 code did not capture any data on laterality (left or right) or ulcer depth/severity. The ICD-9 captured 69 of 81 incident ulcers (85%) and 94% of heel and midfoot ulcers, whereas the ICD-10 code captured 78 of 81 incident ulcers (96%) and all incident heel or midfoot ulcers. Sensitivity and specificity for ulcer characteristics were consistently lower in ICD-9 than in ICD-10.
Conclusions:
The ICD-9 and ICD-10 are similar for data capture on health history variables, but wound variables are captured more accurately using ICD-10. The increased specificity of ICD-10 for ulcer location and severity improves identification and tracking ulcers during an episode of care.
