Diagnosis and coding of opioid misuse: a systematic scoping review and implementation framework

Area of Science:

• Health Informatics
• Public Health
• Pharmacology

Background:

• Administrative coding systems like the International Classification of Diseases (ICD) are crucial for healthcare data analysis.
• Accurate coding of opioid misuse is essential for public health surveillance and resource allocation.
• Current practices for documenting opioid misuse within the ICD framework exhibit significant heterogeneity.

Purpose of the Study:

• To evaluate current administrative coding practices for opioid misuse.
• To assess the utility of the International Classification of Diseases (ICD) framework for documenting opioid misuse.
• To develop standardized documentation recommendations for opioid misuse.

Main Methods:

• A systematic scoping review following PRISMA-ScR guidelines was conducted.
• Analysis included studies utilizing administrative databases such as electronic health records and insurance claims.
• Data from 19 eligible studies were extracted and analyzed, with study quality assessed using a modified Newcastle-Ottawa Scale.

Main Results:

• The ICD-10 code F11.9* (Opioid use) was the most common method for documenting opioid misuse, differentiating it from opioid use disorder codes (F11.1, F11.2).
• Significant heterogeneity in coding practices was observed across studies.
• Code-based definitions identified only about 50% of cases compared to clinical assessments.

Conclusions:

• ICD-10 code F11.9* can effectively document opioid misuse separately from opioid use disorder.
• Successful implementation necessitates a consensus on the clinical definition of opioid misuse.
• Clear clinical guidelines and enhanced electronic health record integration are required for operationalization.