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Translating coding lists in administrative claims-based research for cardiovascular procedures
Zachary J Wanken1, Peter B Anderson2, Sarah Y Bessen2
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Insights
The transition to International Classification of Diseases Tenth Revision (ICD-10) codes significantly increased the number of codes for vascular procedures. Manual review is essential to ensure clinical relevance of these new ICD-10 codes for healthcare research.
Area of Science:
- Healthcare Informatics
- Medical Coding Systems
- Vascular Surgery Research
Background:
- Administrative claims require validated algorithms to infer clinical events.
- The United States transitioned from International Classification of Diseases Ninth Revision (ICD-9) to ICD-10 in October 2015.
- Deriving new ICD-10 codes from existing ICD-9 codes is crucial for continuity in healthcare research.
Purpose of the Study:
- To describe a method for deriving new ICD-10 codes for vascular procedure outcomes from validated ICD-9 codes.
- To adapt existing validated ICD-9 coding lists for use with the ICD-10 system.
- To ensure the clinical relevance and accuracy of ICD-10 codes for research.
Main Methods:
- Began with validated ICD-9 coding lists for specific vascular procedures.
- Utilized general equivalence mapping tools to translate ICD-9 codes to ICD-10.
- Conducted manual review by multiple authors to ensure clinical relevance and remove duplicates.
Main Results:
- A total of 475 ICD-9 codes translated to 46,630 ICD-10 codes, a 98-fold increase.
- Manual review identified 77% of mapped ICD-10 codes as duplicated or not clinically relevant.
- The final reviewed list contained 4,736 ICD-10 codes, a 49-fold increase from the ICD-9 list.
Conclusions:
- ICD-10 significantly expanded the code set for vascular procedure outcomes.
- Over 75% of codes derived via general equivalence mapping lacked clinical relevance or were duplicates.
- Manual review by clinicians is imperative for accurate ICD-10 code selection in research.
Background:
To effectively use administrative claims for healthcare research, clinical events must be inferred from coding data according to validated algorithms. In October 2015, the United States transitioned from the International Classification of Diseases Ninth Revision (ICD-9) to the Tenth Revision (ICD-10). We describe our method to derive new ICD-10 codes for outcomes after vascular procedures from our prior, validated ICD-9 codes.
Methods:
We began with validated ICD-9 coding lists known to represent outcomes after lower extremity revascularization, thoracic aortic endograft placement, abdominal aortic aneurysm reintervention, and carotid revascularization. We used the publicly available general equivalence mapping tools to derive corresponding ICD-10 codes for each of the ICD-9 codes in our current lists. The resulting lists were then manually reviewed by multiple authors to ensure clinical relevance for appropriate event detection. Clinically nonrelevant and duplicated codes were removed.
Results:
A total of 475 ICD-9 codes were translated to ICD-10 with a 98-fold increase (n = 46,630) in the total number of codes. Overall, we found that 77% of codes (n = 35,833) were either duplicated or not clinically relevant upon manual review. For example, for thoracic aortic endograft placement, 97 ICD-9 codes mapped to 14,661 ICD-10 codes in total. A total of 890 codes were removed as duplicates and 9035 codes were removed during manual clinical review. The resultant, reviewed list contained 4736 ICD-10 codes representing a 49-fold increase from the initial ICD-9 list. Findings were similar across the other procedures studied.
Conclusions:
ICD-10 has expanded the number of codes necessary to describe outcomes after vascular procedures. More than 75% of the codes obtained using the general equivalence mapping database were either duplicated or not clinically relevant. Manual review of codes by researchers with clinical knowledge of the procedures is imperative.
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