Adoption and Utilization Trends of a New Diagnosis Code for Pediatric Intestinal Failure: A multicenter retrospective
Vikram K Raghu1, Scott Rothenberger2, Feras Alissa1
1Department of Pediatric, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Background:
In October 2023, a new ICD-10-CM diagnosis code (K90.83) for intestinal failure (IF) was introduced in the United States. Previous studies have relied on complex algorithms to find intestinal failure patients in large databases.
Objective:
We aimed to characterize the use of the new diagnosis code for intestinal failure and its association with healthcare resource utilization.
Methods:
We conducted a retrospective multicenter cross-sectional study using the Pediatric Health Information System database from October 2023 through December 2025. Pediatric inpatient encounters coded with K90.83 were identified. Temporal trends in code utilization were assessed using hospital fixed-effects Poisson regression with robust standard errors clustered at the hospital level. Secondary analyses examined clinical characteristics and cumulative inpatient utilization among children who ever received an IF diagnosis code.
Results:
We identified 3,362 IF-coded encounters from 1,869 children across 48 hospitals. Median age at first IF-coded encounter was 2.1 years. IF-coded encounters increased linearly by 2.6% per month (incidence rate ratio 1.026, 95% CI 1.012-1.040; p<0.001), corresponding to an approximate 36% annual increase, without a significant change in slope over time. Among IF-coded encounters, 86.9% included parenteral nutrition and 21.9% included CLABSI. Children who ever received an IF diagnosis code accounted for 25,144 inpatient encounters totaling 241,748 hospital days and more than $1.21 billion in standardized inpatient costs.
Conclusions:
Adoption of the IF diagnosis code has increased gradually. Although clinically coherent, incomplete adoption likely underestimates true disease burden. Even when identified solely by diagnosis code, pediatric IF is associated with substantial inpatient morbidity and cost.
