ICD-10-CM coding uncovers the gap between serological and clinically identified coeliac disease prevalence: A...

Area of Science:

• Medical Informatics
• Gastroenterology
• Epidemiology

Background:

• The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a vital global health coding system.
• Limited real-world data exists for epidemiological studies on clinically diagnosed coeliac disease (CD) using ICD-10-CM.

Purpose of the Study:

• To assess the diagnostic adequacy of coeliac disease (CD) in primary care.
• To evaluate the accuracy of the ICD-10-CM code K90.0 for identifying CD.
• To compare the prevalence of clinically diagnosed CD with known seroprevalence.

Main Methods:

• A population-based, cross-sectional study conducted in L'Hospitalet de Llobregat, Catalonia (2005-2020).
• Electronic medical record data using code K90.0 were cross-checked with laboratory and pathology registries.
• Case-by-case validation of CD diagnostic criteria and classification into confirmed or misdiagnosed CD.

Main Results:

• Of 737 patients, 73% had confirmed CD, and 27% were misdiagnosed.
• ICD-10-CM code K90.0 demonstrated high accuracy: 91.63% sensitivity, 99.95% specificity, 63.85% PPV, and 99.99% NPV.
• Clinically diagnosed CD prevalence was 1.99‰, showing a decreasing age-related trend.

Conclusions:

• The ICD-10-CM code K90.0 is a reliable tool for identifying clinically diagnosed CD and aids epidemiological surveillance.
• A significant gap exists between CD seroprevalence (5‰) and clinically diagnosed prevalence (1.99‰), indicating underdiagnosis.
• Implementation of case-finding programs is recommended to reduce coeliac disease underdiagnosis.