Assessment of ICD-10-CM code assignment validity for case finding of outpatient anticoagulant-related bleeding among
Nadine Shehab1, Robert Ziemba2, Kyle N Campbell2
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes effectively identify anticoagulant-related bleeding events in Medicare beneficiaries. However, adverse effect codes are rarely used and miss most bleeding cases.
Area of Science:
- Medical Informatics
- Pharmacovigilance
- Healthcare Data Analysis
Background:
- Anticoagulant medications are widely prescribed, increasing the risk of bleeding events.
- Accurate identification of bleeding events is crucial for patient safety and healthcare management.
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes are used for healthcare billing and data analysis.
Purpose of the Study:
- To evaluate the performance of ICD-10-CM code assignments in identifying bleeding events among Medicare beneficiaries on anticoagulants.
- To assess the accuracy of specific ICD-10-CM codes for emergency department visits and hospitalizations due to bleeding.
Main Methods:
- A study of Medicare fee-for-service beneficiaries prescribed anticoagulants was conducted.
- 206 ICD-10-CM bleeding codes, 5 adverse effect/poisoning codes, and 5 coagulopathy codes were assessed.
- Structured medical record review served as the gold standard for validation, with sensitivity adjusted for bias.
Main Results:
- 57 out of 206 ICD-10-CM codes showed optimal performance for anticoagulant-related bleeding.
- The overall positive predictive value (PPV) was 75.7% and adjusted sensitivity was 70.0%.
- Intracranial bleeding codes had the highest PPV (85.0%) and sensitivity (91.0%). Codes in primary position had high PPV but low sensitivity, which improved when secondary codes were included.
Conclusions:
- The performance of ICD-10-CM codes for identifying bleeding in anticoagulant users varies by bleed type and code position.
- Adverse effect/poisoning codes were underutilized and failed to capture over 90% of anticoagulant-related bleeding cases.
- Careful selection and utilization of ICD-10-CM codes are necessary for accurate identification of bleeding events in this population.
Purpose:
To assess performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code assignments for identifying bleeding events resulting in emergency department visits and hospitalizations among outpatient Medicare beneficiaries prescribed anticoagulants.
Methods:
Performance of 206 ICD-10-CM code assignments indicative of bleeding, five anticoagulant adverse effect/poisoning codes, and five coagulopathy codes (according to Medicare Parts A and B claims) as assessed among Medicare fee-for-service beneficiaries prescribed anticoagulants between October 1, 2015 and September 30, 2016 (according to Part D claims). Structured medical record review was the gold standard for validating the presence of anticoagulant-related bleeding. Sensitivity was adjusted to correct for partial verification bias due to sampling design.
Results:
Based on the study sample of 1166 records (583 cases, 583 controls), 57 of 206 codes yielded the optimal performance for anticoagulant-related bleeding (diagnostic odds ratio, 51; positive predictive value (PPV), 75.7% [95% CI, 72.0%-79.1%]; adjusted sensitivity, 70.0% [95% CI, 63.2%-77.7%]). Codes for intracranial bleeding demonstrated the highest PPV (85.0%) and adjusted sensitivity (91.0%). Bleeding codes in the primary position demonstrated high PPV (86.9%), but low adjusted sensitivity (36.0%). The adjusted sensitivity improved to 69.5% when codes in a secondary position were added. Only one adverse effect/poisoning code was used, appearing in 7.8% of cases and controls (PPV, 71.4% and adjusted sensitivity, 6.8%).
Conclusions:
Performance of ICD-10-CM code assignments for bleeding among patients prescribed anticoagulants varied by bleed type and code position. Adverse effect/poisoning codes were not commonly used and would have missed over 90% of anticoagulant-related bleeding cases.
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