Accuracy of ICD-10-CM encounter diagnoses from health records for identifying self-harm events

Abstract

Objective Assess the accuracy of ICD-10-CM coding of self-harm injuries and poisonings to identify self-harm events. Materials and Methods In 7 integrated health systems, records data identified patients reporting frequent suicidal ideation. Records then identified subsequent ICD-10-CM injury and poisoning codes indicating self-harm as well as selected codes in 3 categories where uncoded self-harm events might be found: injuries and poisonings coded as undetermined intent, those coded accidental, and injuries with no coding of intent. For injury and poisoning encounters with diagnoses in those 4 groups, relevant clinical text was extracted from records and assessed by a blinded panel regarding documentation of self-harm intent. Results Diagnostic codes selected for review include all codes for self-harm, 43 codes for undetermined intent, 26 codes for accidental intent, and 46 codes for injuries without coding of intent. Clinical text was available for review for 285 events originally coded as self-harm, 85 coded as undetermined intent, 302 coded as accidents, and 438 injury events with no coding of intent. Blinded review of full-text clinical records found documentation of self-harm intent in 254 (89.1%) of those originally coded as self-harm, 24 (28.2%) of those coded as undetermined, 24 (7.9%) of those coded as accidental, and 48 (11.0%) of those without coding of intent. Conclusions Among patients at high risk, nearly 90% of injuries and poisonings with ICD-10-CM coding of self-harm have documentation of self-harm intent. Reliance on ICD-10-CM coding of intent to identify self-harm would fail to include a small proportion of true self-harm events.

Measuring accuracy of International Classification of Diseases codes in identification of patients with non-cystic fibrosis bronchiectasis

“…It was found on chart review that 28.2% of those coded as undetermined, 7.9% of those coded as accidental, and 11% of those without coding of intent, qualified for being coded as selfharm. 11 Given that the importance of non-cystic fibrosis bronchiectasis is just gradually emerging in the medical literature, for many physicians this disease might not be considered important to rank in the coding. 12,13 One might sense that physicians with an interest in the disease, or who may be investigating primarily to diagnose bronchiectasis would subsequently code for disease if found on radiography.…”

“…That ICD coding from the medical record may also miss events or illnesses which, although important, were not explicitly included in the physician documentation is demonstrated in a review of the accuracy of ICD-10-CM to identify self-harm events in a series looking at data from patients reporting suicidal ideation. It was found on chart review that 28.2% of those coded as undetermined, 7.9% of those coded as accidental and 11% of those without coding of intent qualified for being coded as self-harm [ 11 ]. Given that the importance of NCFB is just gradually emerging in the medical literature, many physicians might not consider this disease sufficiently important to rank in the coding [ 12 , 13 ].…”

Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project

“…Key adverse clinical outcomes following index ED visit will include repeat self-harm (i.e., having subsequent ED visits for self-harm after the index visit), self-harm method escalation, death by suicide, premature death (e.g., death by any cause before age 70), and not receiving any post-discharge treatment (i.e., not having any inpatient or outpatient psychiatric care registered in the period following ED discharge). Building on previous evidence [ 74 , 75 ], data-driven diagnostic algorithms will be developed to facilitate accurate identification of self-harm incidents in the registry data.…”

Predicting risk of suicidal behavior from insurance claims data vs. linked data from insurance claims and electronic health records

“…cases and that reliance on ICD-10-CM self-harm coding would underestimate overall rates of self-harm by 15%. 28 Fatal self-harm events within 90 days of the sampled encounter were ascertained by linking health system enrollment records to state vital statistics data, including ICD-10 cause of death codes indicating self-harm intent (X60-X84) or undetermined intent (Y10-Y34).…”

“…Reviews of full‐text medical records in these health systems found that ICD‐9‐CM diagnoses of self‐harm intent among people with mental health diagnoses were accompanied by clear documentation of self‐harm intent in 90% of cases and that ICD‐9‐CM diagnoses of undetermined intent among people with mental health diagnoses were accompanied by clear documentation of self‐harm intent in over 80% of cases 20 . Reviews of full‐text medical records in these health systems found that ICD‐10‐CM injury and poisoning diagnoses indicating self‐harm among people with history of suicidal ideation were accompanied by clear documentation of self‐harm intent in 89% of cases and that reliance on ICD‐10‐CM self‐harm coding would under‐estimate overall rates of self‐harm by ~15% 28 …”