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How Accurate Is ICD-10 Coding for Revision Total Knee Arthroplasty?
Mackenzie A Roof1, Katherine Lygrisse1, Lauren Keitel2
1Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
The Journal of Arthroplasty
|September 20, 2021
Summary
The International Classification of Diseases-10 Procedure Coding System (ICD-10-PCS) accurately identifies revision total knee arthroplasty (rTKA) but shows significant inaccuracies in coding specific components. Further evaluation of the coding process is needed for detailed rTKA data collection.
Area of Science:
- Orthopedic Surgery
- Medical Coding Systems
- Health Informatics
Background:
- The International Classification of Diseases-10 (ICD-10) implemented in October 2015 introduced new procedural codes (ICD-10-PCS) for detailed procedure specification.
- These codes aim to enhance data collection in institutional databases, registries, and administrative claims by capturing aspects like laterality and revised components.
- The study focuses on assessing the accuracy of ICD-10-PCS coding specifically for revision total knee arthroplasty (rTKA).
Purpose of the Study:
- To evaluate the accuracy of ICD-10-PCS coding for revision total knee arthroplasty (rTKA).
- To determine if ICD-10-PCS codes adequately capture the specifics of component revision in rTKA procedures.
- To inform the use of ICD-10-PCS for granular data collection in rTKA.
Main Methods:
- A multicenter retrospective analysis of 1906 aseptic rTKAs performed between October 2015 and July 2019.
- Operative reports were reviewed to identify laterality and revised components (tibial, femoral, liner, patellar).
- ICD-10-PCS codes from billing records were compared against operative findings, with accuracy assessed using American Joint Replacement Registry guidelines for removal and replacement codes.
Main Results:
- While 98.0% of rTKAs were correctly identified by at least one ICD-10-PCS code, component replacement coding accuracy was 76.3%.
- When considering both removal and replacement codes, the overall accuracy dropped significantly to 57.0%.
- Approximately 25% of rTKA procedures had incorrect component replacement codes, and over 40% had incorrect removal and replacement codes.
Conclusions:
- ICD-10-PCS coding can reliably indicate that an rTKA procedure has occurred.
- There is a notable inaccuracy in coding which specific components were revised during rTKA.
- Further evaluation of the ICD-10-PCS coding process is recommended before its use for reporting granular rTKA data.
