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Pneumonia Hospitalization Coding Changes Associated With Transition From the 9th to 10th Revision of International
Ryan B Smithee1, Tiffanie M Markus2, Elizabeth Soda3,4
1Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
The ICD-10-CM coding system shows minimal bias for tracking pediatric pneumonia hospitalizations but may affect adult data, particularly for COPD patients.
Area of Science:
- Medical Informatics
- Public Health Surveillance
- Epidemiology
Background:
- Pneumonia hospitalization rates declined after infant pneumococcal conjugate vaccine introduction in 2000.
- The transition to the International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM) coding system occurred in October 2015.
- Evaluating the impact of ICD-10-CM on hospitalization rates is crucial for accurate public health monitoring.
Purpose of the Study:
- To assess the effect of ICD-10-CM implementation on pneumonia hospitalization rates.
- To determine if the new coding system introduces bias compared to the previous ICD-9-CM system.
- To provide an adjustment factor for comparing pre- and post-ICD-10-CM data.
Main Methods:
- Randomly selected 500 hospital records from 1 year before and 1 year after October 2015.
- Utilized a validated ICD-9-CM algorithm and its ICD-10-CM translation to identify pneumonia hospitalizations.
- Recoded records between ICD-10-CM and ICD-9-CM, calculated sensitivity and positive predictive value (PPV), and derived an adjustment factor.
Main Results:
- The ICD-10-CM algorithm demonstrated high sensitivity (94%) and PPV (92%) for children.
- For older adults, sensitivity was 74% and PPV was 79%.
- An adjustment factor of -2.09% was estimated for children and +6.76% for older adults; a coding shift for pneumonia with COPD in adults was noted.
Conclusions:
- The ICD-10-CM algorithm, based on ICD-9-CM, appears reliable for monitoring pediatric pneumonia trends.
- Adult pneumonia coding, especially when associated with COPD, requires further investigation due to observed changes post-ICD-10-CM implementation.
- Continued vigilance in coding practices is necessary for accurate epidemiological surveillance.
Objectives:
To evaluate the impact of International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM) implementation on pneumonia hospitalizations rates, which had declined following pneumococcal conjugate vaccine introduction for infants in 2000.
Methods:
We randomly selected records from a single hospital 1 year before (n = 500) and after (n = 500) October 2015 implementation of ICD-10-CM coding. We used a validated ICD-9-CM algorithm and translation of that algorithm to ICD-10-CM to identify pneumonia hospitalizations pre- and post-implementation, respectively. We recoded ICD-10-CM records to ICD-9-CM and vice versa. We calculated sensitivity and positive predictive value (PPV) of the ICD-10-CM algorithm using ICD-9-CM coding as the reference. We used sensitivity and PPV values to calculate an adjustment factor to apply to ICD-10 era rates to enable comparison with ICD-9-CM rates. We reviewed primary diagnoses of charts not meeting the pneumonia definition when recoded.
Results:
Sensitivity and PPV of the ICD-10-CM algorithm were 94% and 92%, respectively, for young children and 74% and 79% for older adults. The estimated adjustment factor for ICD-10-CM period rates was -2.09% (95% credible region [CR], -7.71% to +3.0%) for children and +6.76% (95% CR, -3.06% to +16.7%) for older adults. We identified a change in coding adult charts that met the ICD-9-CM pneumonia definition that led to recoding in ICD-10-CM as chronic obstructive pulmonary disease (COPD) exacerbation.
Conclusions:
The ICD-10-CM algorithm derived from a validated ICD-9-CM algorithm should not introduce substantial bias for evaluating pneumonia trends in children. However, changes in coding of pneumonia associated with COPD in adults warrant further study.
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