Early impact of the ICD‐10‐CM transition on selected health outcomes in 13 electronic health care databases in the United States

Panozzo, Catherine A.; Woodworth, Tiffany; Welch, Emily; Huang, Ting‐Ying; Her, Qoua L.; Haynes, Kevin; Rogers, Catherine A.; Menzin, Talia J.; Ehrmann, Max; Freitas, K.; Haug, Nicole; Toh, Sengwee

doi:10.1002/pds.4563

Cited by 49 publications

(46 citation statements)

References 27 publications

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“…The US Centers for Medicare and Medicaid Services (CMS) formally set October 1, 2015, as the compliance date for conversion from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) to ICD‐10 diagnostic (ICD‐10‐CM) and procedure (ICD‐10‐PCS) codes . We previously performed a series of descriptive analyses to assess the impact of the coding transition on changes in the incidence and prevalence of select health outcomes and found that outcomes should be assessed on a case‐by‐case basis . Replicating well‐established exposure‐outcome associations in the ICD‐10‐CM era or the period spanning across both ICD‐9‐CM and ICD‐10‐CM eras may also help explore the implications of the transition on drug safety analyses and discover best practices toward minimizing unwanted consequences.…”

Section: Introductionsupporting

confidence: 73%

“…We defined an angioedema event using ICD‐9‐CM (995.1, angioneurotic edema not elsewhere classified) and ICD‐10‐CM codes (see below) that appeared on an inpatient, outpatient, or emergency department claim. We used simple‐forward mapping (SFM), simple‐backward mapping (SBM), and forward‐backward mapping (FBM) referencing the 2017 General Equivalence Mappings (GEMs) from the Centers for Medicare and Medicaid Services to define angioedema in the ICD‐10‐CM era based on the ICD‐9‐CM definition . Briefly, in SFM, translation of ICD‐9‐CM to ICD‐10‐CM codes is conducted by referencing the ICD‐9‐CM to ICD‐10‐CM GEMs conversion file, which contains all ICD‐9‐CM codes (approximately 17 000) mapped to ICD‐10‐CM codes .…”

Section: Methodsmentioning

confidence: 99%

“…We assessed the presence or absence of potential confounders, including history of diabetes, heart failure, ischemic heart disease, and allergic reactions; the combined comorbidity score; nonsteroidal anti‐inflammatory drugs use; and health services utilization metrics, during the 183‐day period prior to the index exposure. In the ICD‐9‐CM era, these conditions and the combined comorbidity score were defined using the same or similar definitions as Toh et al and Gagne et al Pre‐existing health conditions coded in ICD‐10‐CM were defined by SFM, SBM, or FBM using GEMs . For the ICD‐10‐CM combined comorbidity score, we utilized the version that includes ICD‐10 codes from both the ICD‐10‐CA (Canadian modification) and GEMs to define the 20 conditions comprising the summary score, as recommended by Sun et al…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Assessing the impact of the new ICD‐10‐CM coding system on pharmacoepidemiologic studies—An application to the known association between angiotensin‐converting enzyme inhibitors and angioedema

Panozzo

Welch

Woodworth

et al. 2018

Pharmacoepidemiology and Drug

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Section: Introductionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Assessing the impact of the new ICD‐10‐CM coding system on pharmacoepidemiologic studies—An application to the known association between angiotensin‐converting enzyme inhibitors and angioedema

Panozzo

Welch

Woodworth

et al. 2018

Pharmacoepidemiology and Drug

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“…Use of ICD‐10‐CM took effect in October 2015 in the United States, thus accuracy of ICD‐10‐CM codes may evolve. Establishing how codes are presently being used is necessary to allow for monitoring of trends . There were 226 cases (15.0%) among the initial 1500 patients eligible for the study that were not available for review; however, because cases were randomly assigned to reviewers, we would not expect this to bias the study findings.…”

Section: Discussionmentioning

confidence: 99%

Assessment of ICD‐10‐CM code assignment validity for case finding of outpatient anticoagulant‐related bleeding among Medicare beneficiaries

Shehab

Ziemba²,

Campbell³

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To assess performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) code assignments for identifying bleeding events resulting in emergency department visits and hospitalizations among outpatient Medicare beneficiaries prescribed anticoagulants. Methods Performance of 206 ICD‐10‐CM code assignments indicative of bleeding, five anticoagulant adverse effect/poisoning codes, and five coagulopathy codes (according to Medicare Parts A and B claims) as assessed among Medicare fee‐for‐service beneficiaries prescribed anticoagulants between October 1, 2015 and September 30, 2016 (according to Part D claims). Structured medical record review was the gold standard for validating the presence of anticoagulant‐related bleeding. Sensitivity was adjusted to correct for partial verification bias due to sampling design. Results Based on the study sample of 1166 records (583 cases, 583 controls), 57 of 206 codes yielded the optimal performance for anticoagulant‐related bleeding (diagnostic odds ratio, 51; positive predictive value (PPV), 75.7% [95% CI, 72.0%‐79.1%]; adjusted sensitivity, 70.0% [95% CI, 63.2%‐77.7%]). Codes for intracranial bleeding demonstrated the highest PPV (85.0%) and adjusted sensitivity (91.0%). Bleeding codes in the primary position demonstrated high PPV (86.9%), but low adjusted sensitivity (36.0%). The adjusted sensitivity improved to 69.5% when codes in a secondary position were added. Only one adverse effect/poisoning code was used, appearing in 7.8% of cases and controls (PPV, 71.4% and adjusted sensitivity, 6.8%). Conclusions Performance of ICD‐10‐CM code assignments for bleeding among patients prescribed anticoagulants varied by bleed type and code position. Adverse effect/poisoning codes were not commonly used and would have missed over 90% of anticoagulant‐related bleeding cases.

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“…A number of US studies have evaluated the financial impact or differences in incidence or prevalence of adverse health outcomes between the period before and after the transition to ICD-10-CM (Hellman, Lim, Leung, Blount, & Yiu, 2018;Inscore, Gonzales, Rennix, & Jones, 2018;Panozzo et al, 2018). However, the effect of this transition on birth defects prevalence and trends has not been explored.…”

Section: Introductionmentioning

confidence: 99%

The impact of the ICD‐9‐CM to ICD‐10‐CM transition on the prevalence of birth defects among infant hospitalizations in the United States

Salemi

Tanner

Kirby

et al. 2019

Birth Defects Research

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Background Many public health surveillance programs utilize hospital discharge data in their estimation of disease prevalence. These databases commonly use the International Classification of Diseases (ICD) coding scheme, which transitioned from the ICD‐9 clinical modification (ICD‐9‐CM) to ICD‐10‐CM on October 1, 2015. This study examined this transition's impact on the prevalence of major birth defects among infant hospitalizations. Methods Using data from the Agency for Health Care Research and Quality‐sponsored National Inpatient Sample, hospitalizations during the first year of life with a discharge date between January 1, 2012 and December 31, 2016 were used to estimate the monthly national hospital prevalence of 46 birth defects for the ICD‐9‐CM and ICD‐10‐CM timeframes separately. Survey‐weighted Poisson regression was used to estimate 95% confidence intervals for each hospital prevalence. Interrupted time series framework and corresponding segmented regression was used to estimate the immediate change in monthly hospital prevalence following the ICD‐9‐CM to ICD‐10‐CM transition. Results Between 2012 and 2016, over 21 million inpatient hospitalizations occurred during the first year of life. Among the 46 defects studied, statistically significant decreases in the immediate hospital prevalence of five defects and significant increases in the immediate hospital prevalence of eight defects were observed after the ICD‐10‐CM transition. Conclusions Changes in prevalence were expected based on changes to ICD‐10‐CM. Observed changes for some conditions may result from variation in monthly hospital prevalence or initial unfamiliarity of coders with ICD‐10‐CM. These findings may help birth defects surveillance programs evaluate and interpret changes in their data related to the ICD‐10‐CM transition.

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Early impact of the ICD‐10‐CM transition on selected health outcomes in 13 electronic health care databases in the United States

Cited by 49 publications

References 27 publications

Assessing the impact of the new ICD‐10‐CM coding system on pharmacoepidemiologic studies—An application to the known association between angiotensin‐converting enzyme inhibitors and angioedema

Assessing the impact of the new ICD‐10‐CM coding system on pharmacoepidemiologic studies—An application to the known association between angiotensin‐converting enzyme inhibitors and angioedema

Assessment of ICD‐10‐CM code assignment validity for case finding of outpatient anticoagulant‐related bleeding among Medicare beneficiaries

The impact of the ICD‐9‐CM to ICD‐10‐CM transition on the prevalence of birth defects among infant hospitalizations in the United States

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