Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

Abstract

Purpose Taiwan’s national health insurance (NHI) database is a valuable resource for large-scale epidemiological and long-term survival research for out-of-hospital cardiac arrest (OHCA). We developed and validated case definition algorithms for OHCA based on the International Classification of Diseases (ICD) diagnostic codes and billing codes for NHI reimbursement. Patients and Methods Claims data and medical records of all emergency department visits from 2010 to 2020 were retrieved from the hospital’s research-based database. Death-related diagnostic codes and keywords were used to identify potential OHCA cases, which were ascertained by chart reviews. We tested the performance of the developed OHCA algorithms and validated them on an external dataset. Results The algorithm defining OHCA as any cardiac arrest (CA)-related ICD code in the first three diagnosis fields performed the best with a sensitivity of 89.5% (95% confidence interval [CI], 88.2–90.7%), a positive predictive value (PPV) of 90.6% (95% CI, 89.4–91.8%), and a kappa value of 0.900 (95% CI, 0.891–0.909). The second-best algorithm consists of any CA-related ICD code in any diagnosis field with a billing code for triage acuity level 1, achieving a sensitivity of 85.6% (95% CI, 84.1–87.0%), a PPV of 93.6% (95% CI, 92.5–94.5), and a kappa value of 0.894 (95% CI, 0.884–0.903). Both algorithms performed well in external validation. In subgroup analyses, the former algorithm performed the best in adult patients, outpatient claims, and during the ICD-9 era. The latter algorithm performed the best in the inpatient claims and during the ICD-10 era. The best algorithm for identifying pediatric OHCAs was any CA-related ICD code in the first three diagnosis fields with a billing code for triage acuity level 1. Conclusion Our results may serve as a reference for future OHCA studies using the Taiwan NHI database.

Validation of diagnosis codes in healthcare databases in Taiwan, a literature review

“…In 11 reports, investigators evaluated diagnosis codes in the electronic medical record system of convenience sample of selected hospital(s), using manual review of medical records, data from an existing stroke registry, or the Taiwan Death Registry as gold standard 33–43 (Table 4). The validation results were major findings in all 11 articles.…”

“…30 In the other report the survey subjects served as a validation subgroup to evaluate the diagnosis codes for tuberculosis, with the Tuberculosis Registry of Taiwan Centers for Disease Control 31 as gold standard, and the validation result was not a major focus of the report. 32 In 11 reports, investigators evaluated diagnosis codes in the electronic medical record system of convenience sample of selected hospital(s), using manual review of medical records, data from an existing stroke registry, or the Taiwan Death Registry as gold standard [33][34][35][36][37][38][39][40][41][42][43] (Table 4). The validation results were major findings in all 11 articles.…”

Validation of ICD-10-CM Diagnostic Codes for Identifying Patients with ST-Elevation and Non-ST-Elevation Myocardial Infarction in a National Health Insurance Claims Database

“…Our previous study indicated that this transition had an impact on the validity of identifying out-of-hospital cardiac arrest cases using ICD-10-CM-based algorithms, with an observable decrease in validity in the first year after the transition. 24 This might be due to unfamiliarity with the new coding system and potential coding errors. To examine whether a similar issue existed in the development of our algorithms, we performed a subgroup analysis to assess the accuracy of the algorithm in different years.…”

Positive Predictive Value of ICD-10-CM Codes for Myocarditis in Claims Data: A Multi-Institutional Study in Taiwan

“…In contrast to other cardiovascular diseases, such as acute coronary syndrome or cardiac arrest, [36][37][38][39][40] the PPV of ICD-10-CM codes for myocarditis is not well understood. To the best of our knowledge, there has been only one validation study, conducted in the Danish National Patient Registry, which reported the PPV of myocarditis (I40, I41, I090, I514) to be 80% as primary diagnosis, and 36% as secondary diagnosis.…”