Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware.
Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware.
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DOI：
10.1186/s12874-017-0361-1
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发表时间：
2017-06-08
影响因子：
4
通讯作者：
McRae A
中科院分区：
文献类型：
--
作者：
Burles K;Innes G;Senior K;Lang E;McRae A
行政数据是研究和质量改进的有用工具;然而，基于这些数据的研究结果的有效性取决于其可靠性。医生指定的诊断随后由疾病学家转换为ICD-10编码（疾病和相关健康问题国际统计分类，第10次修订）。有几个小组报告了住院患者数据中的ICD-9编码错误，这对研究、质量改进和政策制定有影响，但很少有人评估门诊护理数据库中ICD-10编码的有效性。我们的目的是评估肺栓塞（PE）ICD-10编码在我们大型综合医院系统中的准确性，以及使用这些编码进行艾德门诊护理数据库的操作和卫生服务研究的有效性。PE ICD-10代码（I26.0和I26.9）患者（年龄≥ 18岁）的门诊护理数据来自2013年7月至2015年1月期间4家城市ED的记录。通过审查病历和影像学报告证实PE诊断。如果病历诊断和ICD-10代码不一致，则认为病历审查是正确的。还使用“肺栓塞”和“PE”检索了医生的书面出院诊断，并确定了诊断为PE但未编码为PE的患者。编码差异进行了量化和描述。1453例艾德患者有PE ICD-10代码。其中，257例（17.7%）为假阳性，PE代码分配错误。在257例假阳性中，193例病例的艾德诊断不明确，如“排除PE”或“查询PE”，而64例病例应具有非PE代码。另有117例（8.90%）PE出院诊断患者被错误分配了非PE ICD-10代码（假阴性组）。该数据集中PE ICD-10编码的敏感性为91.1%（95%CI，89.4-92.6），特异性为99.9%（95%CI，99.9-99.9）。阳性和阴性预测值分别为82.3%（95%CI，80.3-84.2）和99.9%（95%CI，99.9-99.9）。门诊护理数据，如住院数据，容易出现编码错误。这证实了ICD-10代码在使用前验证的重要性。编码错误的最大比例来自模糊的医生文档;因此，医生和数据保管人必须确保质量改进流程到位，以提高ICD-10编码的准确性。
Administrative data is a useful tool for research and quality improvement; however, validity of research findings based on these data depends on their reliability. Diagnoses assigned by physicians are subsequently converted by nosologists to ICD-10 codes (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Several groups have reported ICD-9 coding errors in inpatient data that have implications for research, quality improvement, and policymaking, but few have assessed ICD-10 code validity in ambulatory care databases. Our objective was to evaluate pulmonary embolism (PE) ICD-10 code accuracy in our large, integrated hospital system, and the validity of using these codes for operational and health services research using ED ambulatory care databases. Ambulatory care data for patients (age ≥ 18 years) with a PE ICD-10 code (I26.0 and I26.9) were obtained from the records of four urban EDs between July 2013 to January 2015. PE diagnoses were confirmed by reviewing medical records and imaging reports. In cases where chart diagnosis and ICD-10 code were discrepant, chart review was considered correct. Physicians’ written discharge diagnoses were also searched using ‘pulmonary embolism’ and ‘PE’, and patients who were diagnosed with PE but not coded as PE were identified. Coding discrepancies were quantified and described. One thousand, four hundred and fifty-three ED patients had a PE ICD-10 code. Of these, 257 (17.7%) were false positive, with an incorrectly assigned PE code. Among the 257 false positives, 193 cases had ambiguous ED diagnoses such as ‘rule out PE’ or ‘query PE’, while 64 cases should have had non-PE codes. An additional 117 patients (8.90%) with a PE discharge diagnosis were incorrectly assigned a non-PE ICD-10 code (false negative group). The sensitivity of PE ICD-10 codes in this dataset was 91.1% (95%CI, 89.4–92.6) with a specificity of 99.9% (95%CI, 99.9–99.9). The positive and negative predictive values were 82.3% (95%CI, 80.3–84.2) and 99.9% (95%CI, 99.9–99.9), respectively. Ambulatory care data, like inpatient data, are subject to coding errors. This confirms the importance of ICD-10 code validation prior to use. The largest proportion of coding errors arises from ambiguous physician documentation; therefore, physicians and data custodians must ensure that quality improvement processes are in place to promote ICD-10 coding accuracy.