<p>Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database</p>

Abstract

The validity of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for the identification of acute ischemic stroke (AIS) in Taiwan's National Health Insurance claims database has not been investigated. This study aimed to construct and validate the case definition algorithms for AIS based on ICD-10-CM diagnostic codes. Patients and Methods: This study identified all hospitalizations with ICD-10-CM code of I63* in any position of the discharge diagnoses from the inpatient claims database and all patients with a final diagnosis of AIS from the stroke registry between Jan 2018 and Dec 2019. Hospitalizations in the claims data that could be successfully linked to those in the registry data were regarded as true episodes of AIS. Otherwise, their electronic medical records and images were manually reviewed to ascertain whether they were true episodes of AIS. Using the true episodes of AIS as the reference standard, the positive predictive value (PPV) and sensitivity of various case definition algorithms for AIS were calculated. Results: A total of 1227 hospitalizations were successfully linked. Among the 155 hospitalizations that could not be linked, 54 were determined to be true episodes of AIS. Using ICD-10-CM code of I63* in any position of the discharge diagnoses to identify AIS yielded a PPV and sensitivity of 92.7% and 99.4%, respectively. The PPV increased to 99.8% with >12% decrease in the sensitivity when AIS was restricted to those with I63* as the primary diagnosis. When AIS was defined to be I63* as the primary, first secondary, or second secondary diagnosis, both PPV and sensitivity were greater than 97%. Conclusion: This study demonstrated the validity of various case definition algorithms for AIS based on ICD-10-CM coding and can provide a reference for future claims-based stroke research.

Validation of ICD-10-CM Diagnosis Codes for Identification of Patients with Acute Hemorrhagic Stroke in a National Health Insurance Claims Database

“…The study findings were similar to our previous study that examined the performance of ICD-10-CM codes for identifying AIS in Taiwan's NHI claims database. 16 Nevertheless, discussing the potential implications for researchers interested in hemorrhagic stroke using this claims database is worthwhile. In contrast to AIS, acute hemorrhagic stroke mainly encompasses SAH (I60) and ICH (I61).…”

“…A previous study on ICD coding for AIS reported a similar finding, which may be explained by the higher prevalence of comorbidities among the elderly. 16 Compared to young adults, elderly subjects carry a higher risk of hemorrhagic transformation of AIS, 22,23 and a higher risk of brain tumor. 24 Furthermore, elderly people are naturally more likely to have chronic or remote hemorrhagic stroke.…”

Psychiatric Comorbidities in Functional Movement Disorders: A Retrospective Cohort Study

“…There is evidence to suggest that there is good concordance between ICD coding and clinical diagnosis in other neurologic conditions, like stroke. 40 More specifically, the use of diagnostic coding for this purpose has been used in previous FMD research, 15,16,41 while also being an accepted strategy for analyzing big datasets of nonneurological diagnoses. 42,43 We attempted to counter the issue of diagnostic accuracy by including only patients with at least one neurology encounter and by examining a subgroup of patients who had a diagnosis of ICD-10 F44-related diagnosis code expressly associated with an outpatient neurology evaluation.…”

“…Use of ICD codes to establish a diagnosis is common to the emerging study of large, retrospective datasets. There is evidence to suggest that there is good concordance between ICD coding and clinical diagnosis in other neurologic conditions, like stroke 40 . More specifically, the use of diagnostic coding for this purpose has been used in previous FMD research, 15,16,41 while also being an accepted strategy for analyzing big datasets of non‐neurological diagnoses 42,43 .…”

Real-World Analyses of the Safety Outcome among a General Population Treated with Statins: An Asian Population-Based Study

“…The accuracy of ICD-9-CM diagnostic codes in Taiwan's NHIRD was verified in previous studies [21][22][23] . Although ICD-10-CM was used in Taiwan for only a few years, there also have been studies validating the diagnostic codes between ICD-9-CM and ICD-10-CM in NHIRD 24,25) . All these study results indicated that records from NHIRD are accurate and consistent between ICD-9-CM and ICD-10-CM.…”