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Inconsistency and Ambiguity Within the International Classification of Disease 10 Procedure Coding System for Hip
Levent A Ozdemir1, Joshua T Anderson1, Benjamin M Stronach1
1Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Insights
The International Statistical Classification of Diseases, 10th Revision Procedure Coding System (ICD-10-PCS) application to hip fractures is frequently inaccurate. Coders struggle with complex definitions, leading to errors in procedural coding for geriatric hip fracture treatments.
Area of Science:
- Medical Coding Accuracy
- Health Informatics
- Orthopedic Surgery Data
Background:
- The International Statistical Classification of Diseases, 10th Revision Procedure Coding System (ICD-10-PCS) was developed to enhance procedural coding detail.
- Concerns exist that the complexity of ICD-10-PCS may lead to data inaccuracies.
Purpose of the Study:
- To evaluate the accuracy of ICD-10-PCS coding for surgically treated geriatric hip fractures.
- To identify inconsistencies between ICD-10-PCS definitions and actual surgical procedures.
Main Methods:
- Review of medical records and ICD-10-PCS codes for geriatric hip fractures treated operatively (January 2016-February 2019).
- Comparison of 7-unit ICD-10-PCS code definitions with medical, operative, and implant records.
Main Results:
- 56% of ICD-10-PCS codes contained ambiguous, partially incorrect, or incorrect figures.
- Arthroplasty procedures showed higher inaccuracy rates (72%) compared to fixation (44.7%).
- Device/implant codes were partially incorrect in 34.9% of cases, with higher rates for hemiarthroplasty.
Conclusions:
- ICD-10-PCS application to hip fracture treatment is inconsistent and often incorrect.
- The system's definitions are challenging for coders and do not accurately reflect surgical procedures.
Background:
The International Statistical Classification of Diseases (ICD), 10th Revision Procedure Coding System (PCS) was created to increase the granularity of procedural coding. These codes are entered by hospital coders from information derived from the medical record. Concern exists that this increase in complexity could lead to inaccurate data.
Methods:
Medical records and ICD-10-PCS codes were reviewed for operatively treated geriatric hip fractures from January 2016 through February 2019 at a tertiary referral medical center. Definitions for each of the 7-unit figures from the 2022 American Medical Association's ICD-10-PCS official codebook were compared to the medical, operative, and implant records.
Results:
There were 56% (135 of 241) of PCS codes that had ambiguous, partially incorrect, or frankly incorrect figures within the code. One or more inaccurate figures were noted in 72% (72 of 100) of fractures treated with arthroplasty compared to 44.7% (63 of 141) treated with fixation (P < .01). There was at least 1 frankly incorrect figure contained in 9.5% (23 of 241) of codes. Approach was coded ambiguously for 24.8% (29 of 117) of pertrochanteric fractures. Device/implant codes were partially incorrect in 34.9% (84 of 241) of all hip fracture PCS codes. Hemi and total hip arthroplasties were partially incorrect in 78.4% (58 of 74) and 30.8% (8/26) of device/implant codes, respectively. Significantly more femoral neck (69.4%, 86 of 124) than pertrochanteric fractures (41.9%, 49 of 117) had 1 or more incorrect or partially correct figures (P < .01).
Conclusion:
Despite the increased granularity of ICD-10-PCS codes, the application of this system is inconsistent and often incorrect when applied to hip fracture treatments. The definitions in the PCS system are difficult to be utilized by coders and do not reflect the operation performed.
