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Utilization of Medical Codes for Hypotension in Shock Patients: A Retrospective Analysis
Charles Hunley1, Shannon M E Murphy2, Michael Bershad2
1Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL, USA.
Insights
Hypotension diagnosis codes are underutilized in shock patients, with only 13.3% receiving a code. Coding practices improved significantly by 2017, highlighting the need for better hypotension documentation.
Area of Science:
- Medical Informatics
- Health Services Research
- Clinical Documentation
Background:
- Accurate coding of hypotension is crucial for patient care and research.
- Understanding coding patterns can reveal areas for clinical documentation improvement.
Purpose of the Study:
- To evaluate the utilization of hypotension diagnosis codes among patients with various types of shock.
- To analyze coding trends over a seven-year period (2011-2017).
Main Methods:
- Retrospective analysis of Medicare fee-for-service claims data from 2011-2017.
- Patients with shock diagnoses were classified into cardiogenic, hypovolemic, septic, and other/unspecified shock cohorts.
- International Classification of Diseases (ICD-9-CM and ICD-10-CM) codes were used to identify shock and hypotension diagnoses.
Main Results:
- 13.3% of 2,200,275 shock patients received a hypotension code.
- Hypovolemic shock patients had the highest (18.02%) and septic shock patients the lowest (11.48%) hypotension code utilization.
- Hypotension code use increased significantly from 10.6% in 2014 to 17.9% in 2017 (p <0.0001).
Conclusions:
- Hypotension codes are underutilized in patients with known hypotension.
- Improved coding practices for hypotension are recommended for patients, providers, and researchers.
Purpose:
To evaluate the utilization of hypotension diagnosis codes by shock type and year in known hypotensive patients.
Patients And Methods:
Retrospective analysis of the Medicare fee-for-service claims database. Patients with a shock diagnosis code between 2011 and 2017 were identified using the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM). Based on specific ICD codes corresponding to each shock type, patients were classified into four mutually exclusive cohorts: cardiogenic shock, hypovolemic shock, septic shock, and other/unspecified shock. Annual proportion and counts of cases with at least one hypotension ICD code for each shock cohort were generated to produce 7-year medical code utilization trends. A Cochran-Armitage test for trend was performed to evaluate the statistical significance.
Results:
A total of 2,200,275 shock patients were analyzed, 13.3% (n=292,192) of which received a hypotension code. Hypovolemic shock cases were the most likely to receive a hypotension code (18.02%, n=46,544), while septic shock cases had the lowest rate (11.48%, n=158,348). The proportion of patients with hypotension codes for other cohorts were 18.0% (n=46,544) for hypovolemic shock and 16.9% (n=32,024) for other/unspecified shock. The presence of hypotension codes decreased by 0.9% between 2011 and 2014, but significantly increased from 10.6% in 2014 to 17.9% in 2017 (p <0.0001, Z=-105.05).
Conclusion:
Hypotension codes are remarkably underutilized in known hypotensive patients. Patients, providers, and researchers are likely to benefit from improved hypotension coding practices.
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