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  11. A Multihospital, Single Health System Validation Of International Classification Of Diseases, 10th Revision, Clinical Modification Coding For Status Epilepticus In The United States

A multihospital, single health system validation of International Classification of Diseases, 10th Revision, Clinical Modification coding for status epilepticus in the United States

Megan MacKenzie1, Nathalie Jette2, Brian J Johnson3

  • 1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Epilepsia
|June 14, 2025

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View abstract on PubMed

Summary
This summary is machine-generated.

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for status epilepticus (SE) show high specificity but limited sensitivity in US populations. Improvements in coding practices are needed to accurately represent SE prevalence.

Area of Science:

  • Neurology
  • Health Informatics
  • Epidemiology

Background:

  • Status epilepticus (SE) is a critical neurological emergency requiring accurate population-level outcome assessment.
  • Validation of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for SE is crucial since their 2015 adoption in the US.
  • Previous studies suggest a potential decrease in SE prevalence post-ICD-10-CM transition, possibly due to coding differences.

Purpose of the Study:

  • To evaluate the accuracy of ICD-10-CM code-based definitions in identifying status epilepticus (SE) within a US hospital setting.
  • To determine the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10-CM coding for SE.

Main Methods:

  • Retrospective chart review of intensive care unit (ICU) admissions at Mount Sinai Health System (MSHS) in 2019.
Keywords:
ICD‐10‐CMepilepsystatus epilepticus

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  • Inclusion of all age groups (excluding neonates) with chart review data linked to electronic medical records.
  • Calculation of performance metrics (Sensitivity, Specificity, PPV, NPV, Youden index) for ICD-10-CM code G40.xx1.

    • Main Results:

    • The ICD-10-CM case definition (G40.xx1) demonstrated high specificity (92.6%) but limited sensitivity (68.7%).
    • Positive Predictive Value (PPV) was 47.4%, and Negative Predictive Value (NPV) was 96.8%.
    • The Youden index was 61.3%, indicating moderate accuracy.

    Conclusions:

    • ICD-10-CM coding for status epilepticus (SE) in the US exhibits high specificity but insufficient sensitivity.
    • The absence of a standalone SE code (G41) in the US version of ICD-10-CM may contribute to underestimation of SE prevalence.
    • Recommendations include revising and improving coding practices to accurately reflect SE prevalence and informing future ICD coding iterations.