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The ICD-9 to ICD-10 transition has not improved identification of rapidly progressing stage 3 and stage 4 chronic
Kabir Jalal1, Andre Charest2, Xiaoyan Wu2
1Department of Biostatistics, University at Buffalo, State University of New York, 807 Kimball Tower, 14214-3000, Buffalo, NY, USA. kjalal@buffalo.edu.
Insights
The International Classification of Diseases (ICD)-10 codes show poor accuracy in identifying patients with rapidly progressing chronic kidney disease (CKD). Despite revisions, diagnostic performance for advanced CKD stages remains a significant concern.
Area of Science:
- Nephrology
- Medical Informatics
- Health Services Research
Background:
- The International Classification of Diseases (ICD) is the standard for disease classification, billing, and epidemiology.
- Prior studies indicate poor accuracy of ICD codes, especially for rapidly progressing chronic kidney disease (CKD).
- The ICD system was revised to version 10 in 2016.
Purpose of the Study:
- To evaluate the accuracy of ICD-10 CKD-staging codes in diagnosing patients with rapidly progressing CKD.
- To compare the diagnostic accuracy of ICD-10 codes against clinical estimations of CKD progression.
Main Methods:
- Analysis of serial outpatient serum creatinine measurements (2016-2021) from 315,903 patients to calculate estimated glomerular filtration rate (eGFR) for clinical CKD staging (eGFR-CKD).
- Comparison of CKD staging based on ICD-10 codes (ICD-CKD) for 59,386 patients against eGFR-CKD diagnoses.
- Assessment of diagnostic accuracy metrics (sensitivity, positive predictive value) for both methods across different CKD stages.
Main Results:
- For rapid progressors, sensitivity was 5.56% and PPV was 5.6% for ICD-CKD compared to eGFR-CKD.
- For stage-3 CKD, ICD-10 sensitivity was 50.34% (PPV 58.71%), an improvement over previous versions.
- For stage-5 CKD, ICD-10 sensitivity was 59.02% (PPV 35.85%), which is a poor comparison to clinical assessment (91.05%).
Conclusions:
- Recent ICD revisions have not significantly improved the diagnostic accuracy for identifying rapid CKD progressors.
- While ICD-10 shows increased sensitivity and PPV for stages 3 and 4 CKD, its performance for stage 5 CKD remains inadequate.
- The findings highlight limitations in using ICD-10 codes for precise CKD staging and progression monitoring.
Background:
The International Classification of Diseases (ICD) coding system is the industry standard tool for billing, disease classification, and epidemiology purposes. Prior research has demonstrated ICD codes to have poor accuracy, particularly in relation to rapidly progressing chronic kidney disease (CKD) patients. In 2016, the ICD system moved to revision 10. This study examines subjects in a large insurer database to determine the accuracy of ICD-10 CKD-staging codes to diagnose patients rapidly progressing towards end-stage kidney disease (ESKD).
Patients And Methods:
Serial observations of outpatient serum creatinine measurements from 2016 to 2021 of 315,903 patients were transformed to estimated glomerular filtration rate (eGFR) to identify CKD stage-3 and advanced patients diagnosed clinically (eGFR-CKD). CKD-staging codes from the same time period of 59,386 patients and used to identify stage-3 and advanced patients diagnosed by ICD-code (ICD-CKD). eGFR-CKD and ICD-CKD diagnostic accuracy was compared between a total of 334,610 patients.
Results:
5,618 patients qualified for the progression analysis; 72 were identified as eGFR rapid progressors; 718 had multiple codes to qualify as ICD rapid progressors. Sensitivity was 5.56%, with positive predictive value (PPV) 5.6%. 34,858 patients were diagnosed as eGFR-CKD stage-3 patients; 17,549 were also diagnosed as ICD-CKD stage-3 patients, for a sensitivity of 50.34%, with PPV of 58.71%. 4,069 patients reached eGFR-CKD stage-4 with 2,750 ICD-CKD stage-4 patients, giving a sensitivity of 67.58%, PPV of 42.43%. 959 patients reached eGFR-CKD stage-5 with 566 ICD-CKD stage-5 patients, giving a sensitivity of 59.02%, PPV of 35.85%.
Conclusion:
This research shows that recent ICD revisions have not improved identification of rapid progressors in diagnostic accuracy, although marked increases in sensitivity for stage-3 (50.34% vs. 24.68%), and PPV in stage-3 (58.71% vs. 40.08%), stage-4 (42.43% vs. 18.52%), and stage-5 (35.85% vs. 4.51%) were observed. However, sensitivity in stage-5 compares poorly (59.02% vs. 91.05%).
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