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Validity of administrative codes associated with cirrhosis in Sweden

Bonnie Bengtsson1,2, Johan Askling3,4, Jonas F Ludvigsson5,6,7,8

  • 1Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.

Scandinavian Journal of Gastroenterology
|September 22, 2020
PubMed

Insights

The International Classification of Diseases, 10th revision (ICD-10) codes for cirrhosis and its complications generally show high validity in the Swedish National Patient Register (NPR). However, coding for ascites requires combining with chronic liver disease codes for accuracy.

Area of Science:

  • Hepatology
  • Medical Informatics
  • Public Health Surveillance

Background:

  • Cirrhosis is a significant global cause of liver-related mortality.
  • Validation studies for administrative coding of cirrhosis diagnoses are limited.
  • Accurate coding is crucial for epidemiological research and healthcare management.

Purpose of the Study:

  • To validate the accuracy of International Classification of Diseases, 10th revision (ICD-10) codes for cirrhosis and its complications.
  • To assess the reliability of the Swedish National Patient Register (NPR) for cirrhosis-related diagnoses.

Main Methods:

  • Random selection of 750 patients with specific ICD-10 codes for cirrhosis, oesophageal varices, hepatocellular carcinoma (HCC), or ascites from the NPR (2000-2016).
  • Inclusion of hospitalisation events and specialised outpatient visits.
  • Calculation of positive predictive values (PPVs) using patient charts as the gold standard.

Main Results:

  • High PPVs were observed for alcohol-related cirrhosis (93%), unspecified cirrhosis (91%), and oesophageal varices (96%).
  • Hepatocellular carcinoma (HCC) coding showed a PPV of 84%.
  • The PPV for liver-related ascites was low (43%) but increased to 93% when combined with chronic liver disease codes.

Conclusions:

  • ICD-10 codes for cirrhosis, oesophageal varices, and HCC demonstrate high validity in the NPR.
  • Coding for ascites requires augmentation with a chronic liver disease code to ensure acceptable validity.
  • Findings support the use of NPR data for cirrhosis research with specific coding considerations for ascites.
Abstract

Keywords:
CirrhosisICD-10ascitesepidemiologyhepatocellular carcinomaoesophageal varicesvalidation

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