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Validation of ICD-10 Codes for Gestational and Pregestational Diabetes During Pregnancy in a Large, Public Hospital
Kaitlyn K Stanhope1, Naima T Joseph1, Marissa Platner1
1From the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
Insights
ICD-10 billing codes accurately identify gestational and pregestational diabetes cases, showing high specificity and negative predictive values. This validation is crucial for reliable diabetes surveillance and quality improvement in maternal health.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Health Informatics
Background:
- International Classification of Diseases, 10th Revision (ICD-10) codes are widely used for tracking gestational and pregestational diabetes in clinical settings.
- Potential misclassification of diagnoses using ICD-10 codes can introduce bias in quality improvement, research, and surveillance efforts.
- Accurate identification of diabetes cases during pregnancy is essential for effective patient care and epidemiological studies.
Purpose of the Study:
- To estimate the validation parameters (sensitivity, specificity, positive predictive value, negative predictive value) of ICD-10 codes for diagnosing gestational and pregestational diabetes.
- To compare ICD-10 code accuracy against medical record abstraction, considered the gold standard.
- To assess the reliability of ICD-10 coding for diabetes in pregnancy at a large public hospital.
Main Methods:
- A retrospective study was conducted at Grady Memorial Hospital in Atlanta, Georgia, involving 3,654 deliveries between 2016 and 2018.
- Medical records were abstracted and linked to corresponding ICD-10 diagnosis codes for gestational and pregestational diabetes.
- Validation metrics including sensitivity, specificity, positive predictive value, and negative predictive value were calculated using medical record data as the reference standard.
Main Results:
- ICD-10 codes demonstrated high specificity (>99%) and negative predictive value (>99%) for both pregestational and gestational diabetes.
- For pregestational diabetes, sensitivity was 85.9% and positive predictive value was 90.8%.
- For gestational diabetes, sensitivity was 95% and positive predictive value was 86%.
Conclusions:
- ICD-10 codes provide accurate identification of pregestational and gestational diabetes cases in a large public hospital setting.
- The low number of false positives indicates a high degree of reliability for these codes in clinical and research applications.
- These findings support the continued use of ICD-10 codes for diabetes surveillance and quality improvement initiatives in maternal healthcare.
Background:
The use of billing codes (ICD-10) to identify and track cases of gestational and pregestational diabetes during pregnancy is common in clinical quality improvement, research, and surveillance. However, specific diagnoses may be misclassified using ICD-10 codes, potentially biasing estimates. The goal of this study is to provide estimates of validation parameters (sensitivity, specificity, positive predictive value, and negative predictive value) for pregestational and gestational diabetes diagnosis using ICD-10 diagnosis codes compared with medical record abstraction at a large public hospital in Atlanta, Georgia.
Methods:
This study includes 3,654 deliveries to Emory physicians at Grady Memorial Hospital in Atlanta, Georgia, between 2016 and 2018. We linked information abstracted from the medical record to ICD-10 diagnosis codes for gestational and pregestational diabetes during the delivery hospitalization. Using the medical record as the gold standard, we calculated sensitivity, specificity, positive predictive value, and negative predictive value for each.
Results:
For both pregestational and gestational diabetes, ICD-10 codes had a high-negative predictive value (>99%, Table 3) and specificity (>99%). For pregestational diabetes, the sensitivity was 85.9% (95% CI = 78.8, 93.0) and positive predictive value 90.8% (95% CI = 85, 97). For gestational diabetes, the sensitivity was 95% (95% CI = 92, 98) and positive predictive value 86% (95% CI = 81, 90).
Conclusions:
In a large public hospital, ICD-10 codes accurately identified cases of pregestational and gestational diabetes with low numbers of false positives.
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