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Comparison of crosswalk methods for translating ICD-9 to ICD-10 diagnosis codes for child maltreatment
Kathleen A Noorbakhsh1, Rachel P Berger2, Sriram Ramgopal3
1Division of Emergency Medicine, Department of Pediatrics, University of Pittsburgh Medical Center, 4401 Penn Ave, Pittsburgh, PA 15224, United States.
Insights
Developing reliable International Classification of Disease (ICD) 10th revision codes for child maltreatment is crucial. Current conversion methods are inconsistent, necessitating new, validated ICD-10 definitions for accurate research and surveillance.
Area of Science:
- Public Health
- Medical Informatics
- Pediatrics
Background:
- A validated International Classification of Disease (ICD) 10th revision (ICD-10) code set for identifying child maltreatment is currently unavailable.
- Such a code set is essential for administrative data-based research and public health surveillance of child maltreatment.
- Existing research relies on ICD 9th edition, clinical modification (ICD-9-CM) codes, necessitating a transition to ICD-10-CM.
Purpose of the Study:
- To evaluate the validity of child maltreatment diagnosis code classifications after conversion from ICD-9-CM to ICD-10-CM.
- To assess the effectiveness of General Equivalence Mappings (GEMs) and network-based mappings for this transition.
Main Methods:
- Utilized two large, multicenter hospital-based datasets (PHIS and KID) containing children with ICD-9-CM/ICD-10-CM diagnosis codes for child maltreatment.
- Evaluated the performance of GEMs and network-based mappings using previously validated ICD-9-CM codes and their resulting ICD-10-CM codes across different time periods.
- Compared the proportion of children diagnosed with specific maltreatment codes in the ICD-9-CM and ICD-10 eras.
Main Results:
- General Equivalence Mappings (GEMs) identified a limited number of comparable diagnoses (15 in KID, 14 in PHIS).
- Network-based mapping identified more comparable diagnoses (18 in KID, 13 in PHIS), but showed significant discrepancies for some codes.
- For six diagnoses, network-based mapping in the ICD-10 era resulted in proportions over ten times higher than in the ICD-9-CM era.
Conclusions:
- Neither GEMs nor network-based mapping provided consistently reliable conversions between ICD-9-CM and ICD-10-CM for child maltreatment codes.
- Methodological limitations of crosswalks and inherent changes in ICD-10-CM contribute to conversion inaccuracies.
- There is a critical need to independently develop and validate ICD-10-based definitions for child maltreatment to support future research and surveillance efforts.
Background:
A validated source of International Classification of Disease (1CD) 10th revision diagnostic codes to identify child maltreatment has not been developed. Such a reference would be essential for the practical purposes of administrative data-based research and public health surveillance.
Objective:
To evaluate the validity of diagnosis code classifications for child maltreatment following conversion from ICD 9th edition, clinical modification (ICD-9-CM) to 10th revision.
Participants And Setting:
Children receiving inpatient or emergency medical care in the United States with ICD-9-CM/ICD-10-CM diagnosis codes for child maltreatment, identified using two large multicenter hospital-based datasets.
Methods:
We evaluated the performance of general equivalence mappings (GEMs) and network-based mappings for previously-validated ICD-9-CM diagnosis codes for child maltreatment in the 2013-2014 PHIS and 2012 KID and resulting ICD-10-CM codes in the 2018-2019 PHIS and 2016 KID datasets.
Results:
Of 56 previously-validated ICD-9-CM diagnoses, GEMs identified 15 with a similar proportion of diagnosed children in the KID ICD-9-CM and ICD-10 eras and 14 diagnoses in PHIS. Network-based mapping identified 18 diagnoses with similar proportions in the KID datasets, and 13 diagnoses in PHIS. For six diagnoses, the proportion of children identified in the ICD-10 era using network-based mapping was more than ten times the proportion identified in the ICD-9-CM era.
Conclusion:
Neither crosswalk method provided consistently reliable conversions, due to both crosswalk methodology and changes introduced by the ICD 10th revision. These findings highlight the need for independent construction and validation of ICD-10-based definitions of child maltreatment as a precursor to administrative data-based research and public health surveillance.
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