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Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses: Analysis of ICD-10-CM Transition, 2013-2017
Jean Y Ko1,2, Ashley H Hirai3, Pamela L Owens4
1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta fob1@cdc.gov.
Insights
The transition to ICD-10-CM coding did not impact neonatal abstinence syndrome (NAS) rates but altered maternal opioid use disorder (OUD) and opioid-related diagnosis surveillance. This coding change may affect how we track the opioid crisis in pregnant women and infants.
Area of Science:
- Public Health Surveillance
- Maternal and Child Health
- Healthcare Informatics
Background:
- Hospital discharge records are crucial for monitoring the opioid crisis in pregnant women and infants.
- The transition from ICD-9-CM to ICD-10-CM coding may have influenced surveillance accuracy.
- Understanding these changes is vital for reliable tracking of maternal and infant opioid use.
Purpose of the Study:
- To evaluate the impact of the ICD-10-CM transition on surveillance rates.
- Specifically assessed changes in neonatal abstinence syndrome (NAS), maternal opioid use disorder (OUD), and opioid-related diagnoses.
Main Methods:
- Utilized data from the 2013-2017 Healthcare Cost and Utilization Project's National Inpatient Sample.
- Employed interrupted time series analysis and log-binomial segmented regression.
- Assessed quarterly rate differences across the ICD-9-CM to ICD-10-CM transition period.
Main Results:
- The ICD-10-CM transition showed no significant association with NAS rates (RR: 0.99; 95% CI: 0.90-1.08).
- Maternal OUD rates decreased by 11% (RR: 0.89; 95% CI: 0.80-0.98), with a decreasing trend (RR: 0.98; 95% CI: 0.96-1.00).
- Opioid-related diagnoses, including long-term and unspecified use, increased by 20% (RR: 1.20; 95% CI: 1.09-1.32).
Conclusions:
- The ICD-10-CM transition did not appear to affect neonatal abstinence syndrome (NAS) rates.
- Coding of maternal opioid use disorder (OUD) alone may not consistently capture the same population across the transition.
- This coding shift complicates the interpretation of trend data for maternal OUD spanning the ICD-9-CM and ICD-10-CM periods.
Background And Objectives:
Hospital discharge records remain a common data source for tracking the opioid crisis among pregnant women and infants. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) transition from the International Classification of Diseases, Ninth Revision, Clinical Modification may have affected surveillance. Our aim was to evaluate this transition on rates of neonatal abstinence syndrome (NAS), maternal opioid use disorder (OUD), and opioid-related diagnoses (OUD with ICD-10-CM codes for long-term use of opioid analgesics and unspecified opioid use).
Methods:
Data from the 2013-2017 Healthcare Cost and Utilization Project's National Inpatient Sample were used to conduct, interrupted time series analysis and log-binomial segmented regression to assess whether quarterly rates differed across the transition.
Results:
From 2013 to 2017, an estimated 18.8 million birth and delivery hospitalizations were represented. The ICD-10-CM transition was not associated with NAS rates (rate ratio [RR]: 0.99; 95% confidence interval [CI]: 0.90-1.08; P = .79) but was associated with 11% lower OUD rates (RR: 0.89; 95% CI: 0.80-0.98; P = .02) and a decrease in the quarterly trend (RR: 0.98; 95% CI: 0.96-1.00; P = .04). The transition was not associated with maternal OUD plus long-term use rates (RR: 0.98; 95% CI: 0.89-1.09; P = .76) but was associated with a 20% overall increase in opioid-related diagnosis rates including long-term and unspecified use (RR: 1.20; 95% CI: 1.09-1.32; P < .001).
Conclusions:
The ICD-10-CM transition did not appear to affect NAS. However, coding of maternal OUD alone may not capture the same population across the transition, which confounds the interpretation of trend data spanning this time period.
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