No abstract

No abstract

Key MessagesAccurate anaphylaxis diagnosis is imperative for first-line treatment and providing high-quality and safe care. Programs to train frontline providers on recognition are imperative for anaphylaxis diagnosis, management, and coding.Anaphylactic shock-specific reimbursement codes, without associated algorithm use or retrospective chart review, have poor positive predictive value for anaphylaxis.Diagnosis underreporting and inaccurate recognition of anaphylaxis can cloud the pragmatic use of reimbursement codes to identify anaphylaxis in large administrative claims databases.We remain hopeful that ICD-11 reclassification and improvements in clinical decision support tools as well as education can further improve the accuracy of anaphylaxis detection. A B S T R A C TObjective: The identification of anaphylaxis cases is imperative for optimal clinicalprovider knowledge deficiencies in diagnosis and treatment and the efficacy of reimbursement codes, such as International Classification of Diseases (ICD) and current procedural terminology (CPT) codes, in detecting anaphylaxis. Data Sources: Pubmed. Study Selections: Recent and clinically relevant literature on anaphylaxis and provider knowledge, ICD, CPT, Healthcare Common Procedural Coding System (HCPCS), and E-codes were selected and reviewed. Results: Reimbursement codes are used to detect anaphylaxis in administrative claims databases. Inaccurate recognition of the diagnosis by providers, underreporting, and cause identification are challenges faced by health researchers using reimbursement codes for anaphylaxis case identification. Anaphylactic shockespecific ICD codes were noted to have a positive predictive value (PPV) of 52% to 53% of anaphylaxis events compared with physician chart review, which was improved to 63% to 67.3% when used in conjunction with anaphylaxis symptom-specific ICD, CPT, HCPCS, and E-codes 31, 34, and 35. Conclusion: Education of providers to properly diagnose and treat anaphylaxis requires systematic and educational investments. The ICD codes specific to anaphylactic shock have suboptimal PPV to identify anaphylaxis in administrative claims databases. Use of algorithms incorporating other reimbursement codes improve the PPV, but they are limited by inaccurate diagnoses and underreporting of anaphylaxis. Future ICD-11 reclassification may improve anaphylaxis detection by reimbursement codes.