ICD-10 Diagnostic Coding for Identifying Hospitalizations Related to a Diabetic Foot Ulcer

Abstract

Purpose: To estimate the positive predictive value (PPV) of Canadian ICD-10 diagnostic coding for the identification of hospitalization related to a diabetic foot ulcer (DFU). Methods: Hospitalizations related to a neuropathic and/or ischemic DFU were identified from the Discharge Abstract Database (DAD) records of a single Canadian tertiary care hospital between April 1, 2002 and March 31, 2019. The first coding approach required a most responsible diagnosis (MRDx) code for diabetes-specific foot ulceration or gangrene (DSFUG group). Three alternative coding approaches were also considered: MRDx code for lower-limb osteomyelitis (osteomyelitis group); lower-limb ulceration (LLU group); or lower-limb atherosclerotic gangrene (atherosclerosis group)—each in conjunction with a non-MRDx DSFUG code on the same DAD record. From all eligible DAD records, random samples were drawn for each coding group. DAD records were independently compared by a masked reviewer who manually abstracted data from the entire hospital record (reference standard). The PPV and 95% CI were generated. Results: Out of 1,460 hospitalizations, a total of 300, 50, 33 and seven records were included from the DSFUG, osteomyelitis, LLU and atherosclerosis samples, respectively. Compared to the reference standard, the PPV for all 390 records was 88.5% (95% CI 84.9 to 91.5). The DSFUG group had the highest PPV (90.0%, 95% CI 86.0 to 93.2), followed by the atherosclerosis (85.7%, 95% CI 42.1 to 99.6), LLU (84.9%, 95% CI 68.1 to 94.9) and osteomyelitis (82.0%, 95% CI 68.6 to 91.4) groups. Conclusion: Based on data from a Canadian tertiary care hospital, the specified coding algorithms can be used to identify and study the management and outcomes of people hospitalized with a DFU in Ontario.

Metformin and the risks of cellulitis, foot infections, and amputation in patients with type 2 diabetes

“…4,8 A US cohort study revealed that diabetes mellitus had association with a significantly increased risk of hospitalization for infections, and the risk was most prominent for foot infection (HR, 5.99; 95% CI, 4.38-8.19). 25 Without proper treatment, foot infections may progress from cellulitis to osteomyelitis; cellulitis may also lead to foot ulcers. A deteriorated foot infection may necessitate an amputation to save a life.…”

Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study

“…The following Canadian Classification of Health Intervention (CCI) codes were used to identify major LEA: 1VC93, 1VG93, 1VQ93, and 1WA93. Persons also needed to have a diagnosis of peripheral vascular disease and/or diabetes prior to or at the time of initial LEA hospitalization [ 26 , 27 ]. We excluded those not eligible for health coverage in Ontario or a non-resident of Ontario, invalid death date (died before admission, or died during initial stay), those who were less than 18 years of age or older than 105 years, missing or invalid sex or date of birth, those with a previous major dysvascular LEA event (looked back to 2002), and those with amputations due to trauma, cancer, congenital, or orthopedic causes (see Fig 1 for cohort flow diagram).…”