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Validation of Hypertensive Disorders During Pregnancy: ICD-10 Codes in a High-burden Southeastern United States

Katie Labgold1, Kaitlyn K Stanhope2, Naima T Joseph2

  • 1From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

Epidemiology (Cambridge, Mass.)
|May 19, 2021
PubMed

Insights

International Classification of Diseases v. 10 (ICD-10) codes generally identify hypertensive disorders in pregnancy well, but have low sensitivity for preeclampsia without severe features. These findings offer bias parameters for future research in high-burden populations.

Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Health Informatics

Background:

  • Hypertensive disorders in pregnancy research often relies on International Classification of Diseases v. 10 (ICD-10) codes.
  • Billing-focused ICD-10 codes may introduce misclassification errors compared to medical records.
  • This study evaluates ICD-10 code validity for hypertensive disorders in pregnancy within a high-burden hospital setting.

Purpose of the Study:

  • To estimate the validity of ICD-10 codes for identifying hypertensive disorders during pregnancy.
  • To compare ICD-10 code accuracy against medical record diagnoses (gold standard).
  • To assess validity across various hypertensive subdiagnoses.

Main Methods:

  • Linked medical record and hospital discharge data for deliveries (July 2016-June 2018) at a public hospital in Atlanta, Georgia.
  • Calculated positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for ICD-10 codes versus medical records.
  • Evaluated overall hypertensive disorders and specific subdiagnoses: HELLP syndrome, eclampsia, preeclampsia (with/without severe features), chronic hypertension, superimposed preeclampsia, and gestational hypertension.

Main Results:

  • Overall, ICD-10 codes demonstrated high performance (PPV, NPV, specificity >90%; sensitivity >80%) for hypertensive disorders in pregnancy.
  • High PPV, NPV, and specificity (>80%) were observed for all subdiagnoses.
  • Sensitivity was high for superimposed preeclampsia, chronic hypertension, and gestational hypertension (>80%), moderate for eclampsia and HELLP syndrome, and low for preeclampsia without severe features (3.2%).

Conclusions:

  • ICD-10 codes are generally reliable for identifying hypertensive disorders in pregnancy in high-burden settings.
  • Specific subdiagnoses, particularly preeclampsia without severe features, show lower sensitivity.
  • Provides essential bias parameters for future US-based research utilizing ICD-10 codes for hypertensive pregnancy outcomes.
Abstract

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