Effect of ICD-9 to ICD-10 Transition on Accuracy of Codes for Stage of Diabetic Retinopathy and Related Complications: Results from the CODER Study.
Cai Cindy X, Michalak Suzanne M, Stinnett Sandra S, Muir Kelly W, Fekrat Sharon, Borkar Durga S
AI Summary
This study found ICD-10 coding for diabetic retinopathy and its stages, especially PDR, is more accurate than ICD-9, improving clinical database research potential.
Abstract
Purpose
When the International Classification of Diseases 9th Revision (ICD-9) transitioned to the International Classification of Diseases 10th Revision (ICD-10), there was a marked increase in the complexity of International Classification of Diseases (ICD) codes with potential for improved specificity in clinical database research. The purpose of this study was to characterize the accuracy of coding for stage of diabetic retinopathy (DR) and DR-related complications (including vitreous hemorrhage, retinal detachment, and neovascular glaucoma) during this transition.
Design
Retrospective chart review of 3 time periods corresponding to the use of ICD-9: 2014-2015; "early" use of ICD-10, 2015-2016; and "late" use of ICD-10, 2018-2019.
Participants
Patients aged 18 years or older with a diagnosis of DR at a multispecialty academic institution.
Methods
Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and kappa (κ) statistics were generated for each diagnosis. Generalized estimating equation (GEE) models were used to assess the significance of the variables.
Main outcome measure: The main outcome was the proportion of agreement between the ICD code and the documented chart standard for stage of DR and DR-related complications.
Results
A total of 600 patients were included in the study (average age, 61 years; range, 25-93 years). Overall, there was substantial agreement between the ICD codes for stage of DR and the documented standard (κ = 0.66). The proportion of ICD codes in agreement with the documented standard diagnosis increased with time: 66.5%, 78.5%, and 83.3% for ICD-9, "early" ICD-10, and "late" ICD-10, respectively. The odds of agreement were 2.67 (95% confidence interval [CI], 1.49-4.76, P < 0.001) and 3.96 (95% CI, 2.34-6.69, P < 0.0001) times greater for "early" and "late" ICD-10 codes compared with ICD-9 codes, respectively. For specific codes, the overall PPV, NPV, sensitivity, and specificity for nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excellent (>90%). The odds of agreement were 19.70 (95% CI, 11.54-33.64, P < 0.0001) times greater for PDR than NPDR. Compared with the stage of DR, DR-related diagnoses were overall less accurately coded (κ = 0.61, 0.48, and 0.52 for vitreous hemorrhage, retinal detachment, and neovascular glaucoma, respectively).
Conclusions
Coding in ICD-10 is more accurate than in ICD-9, particularly for PDR compared with NPDR. The increased accuracy emphasizes the potential for ICD-10 coding to be used effectively in database research.
MeSH Terms
Shields Classification
Key Concepts6
The overall agreement between ICD codes for stage of diabetic retinopathy (DR) and the documented standard was substantial (κ = 0.66) in a retrospective chart review of 600 patients (average age, 61 years; range, 25-93 years) with DR.
The proportion of ICD codes in agreement with the documented standard diagnosis for stage of diabetic retinopathy increased over time: 66.5% for ICD-9 (2014-2015), 78.5% for "early" ICD-10 (2015-2016), and 83.3% for "late" ICD-10 (2018-2019) in a retrospective chart review of 600 patients with DR.
The odds of agreement for ICD-10 codes compared with ICD-9 codes for stage of diabetic retinopathy were 2.67 (95% CI, 1.49-4.76, P < 0.001) times greater for "early" ICD-10 and 3.96 (95% CI, 2.34-6.69, P < 0.0001) times greater for "late" ICD-10 in a retrospective chart review of 600 patients with DR.
For specific codes related to diabetic retinopathy, the overall positive predictive value, negative predictive value, sensitivity, and specificity for nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were excellent (>90%) in a retrospective chart review of 600 patients with DR.
The odds of agreement were 19.70 (95% CI, 11.54-33.64, P < 0.0001) times greater for proliferative diabetic retinopathy (PDR) than nonproliferative diabetic retinopathy (NPDR) coding in a retrospective chart review of 600 patients with DR.
Compared with the stage of diabetic retinopathy, DR-related diagnoses including vitreous hemorrhage (κ = 0.61), retinal detachment (κ = 0.48), and neovascular glaucoma (κ = 0.52) were overall less accurately coded in a retrospective chart review of 600 patients with DR.
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