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Diseases of the Liver and Gallbladder01:26

Diseases of the Liver and Gallbladder

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Liver and gallbladder diseases are a significant health concern, with prominent conditions including cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), and gallstones. Jaundice is a common manifestation of liver and biliary disease.
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
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Cholangiocarcinoma miscoding in hepatobiliary centres.

Shaun Selvadurai1, Kulbir Mann2, Sanjena Mithra3

  • 1Liver Unit, Division of Digestive Diseases, Imperial College London and Imperial College Healthcare NHS Trust, UK.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
|October 9, 2020
PubMed
Summary
This summary is machine-generated.

Coding errors are common for cholangiocarcinoma (CCA), with perihilar CCA frequently miscoded as intrahepatic CCA. This misclassification may inflate intrahepatic CCA incidence rates, highlighting the need for distinct diagnostic codes.

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Area of Science:

  • Oncology
  • Medical Coding
  • Hepatobiliary Medicine

Background:

  • Cholangiocarcinoma (CCA) is classified as intrahepatic (iCCA) or extrahepatic (eCCA), with eCCA further divided into perihilar (pCCA) and distal (dCCA).
  • Current International Classification of Diseases (ICD) versions lack specific topography codes for pCCA.
  • Studies report increasing iCCA incidence and decreasing eCCA rates, potentially influenced by coding practices.

Purpose of the Study:

  • To investigate the hypothesis that the absence of a specific ICD code for pCCA leads to its misclassification as iCCA.
  • To assess the accuracy of CCA coding in UK HepatoPancreatoBiliary (HPB) centers.

Main Methods:

  • Retrospective review of clinical notes for hepatobiliary carcinoma cases coded using ICD-10 criteria between 2015-2017.
  • Independent review by two clinicians across three UK HPB centers to determine the final diagnosis.
  • Comparison of the final diagnosis with the initially allocated ICD-10 code.

Main Results:

  • Out of 625 reviewed CCA cases, 226 were coded as iCCA (C22.1).
  • Of these 226 cases, only 98 (43%) were true iCCA; 76 cases (34%) were actually pCCA.
  • A significant 92% of all pCCA cases were incorrectly coded as iCCA.

Conclusions:

  • Coding misclassification of CCA is prevalent in UK HPB centers, notably the miscoding of pCCA as iCCA.
  • This miscoding may contribute to the reported rise in iCCA incidence rates.
  • Distinct topographical codes for iCCA, pCCA, and dCCA are necessary in future ICD revisions.