Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland.
ML Barrett, Inc., Del Mar, California.
Alcohol Clin Exp Res. 2018 Nov;42(11):2205-2213. doi: 10.1111/acer.13866. Epub 2018 Aug 31.
In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses.
This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods.
On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder.
Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the ICD-10-CM transition is to aggregate diagnosis codes into broader, clinically meaningful groups-including a single global group that encompasses all alcohol-related stays-and then to select diagnostic groupings that minimize discontinuities between the 2 coding systems while providing useful information on this important indicator of population health.
2015 年 10 月，美国将医疗诊断代码从国际疾病分类，第九修订版，临床修正（ICD-9-CM）转换为第十版（ICD-10-CM）。对与酒精相关的住院治疗趋势的分析可能仅由于分类系统的变化而显示出不连续性。本研究检查了 ICD-10-CM 编码系统对涉及酒精相关诊断的住院治疗估计的影响。
本分析使用了来自 17 个州的医疗保健研究和质量医疗保健成本和利用项目州住院数据库的 2014 年至 2017 年的行政数据。将 2014 年第二季度至 2015 年第三季度的季度 ICD-9-CM 数据与 2015 年第四季度至 2017 年第一季度的 ICD-10-CM 数据拼接在一起。总体上检查了与酒精相关的住院治疗的季度计数，然后按 6 个诊断亚组进行检查：戒断，滥用，依赖，酒精引起的精神障碍（AIMD），非精神病性酒精引起的疾病以及中毒或毒性作用。在每个组中，我们计算了 ICD-9-CM 和 ICD-10-CM 编码期间平均住院次数的差异。
平均而言，在 ICD-10-CM 转换前后的 6 个季度中，涉及任何酒精相关诊断的住院次数保持稳定。然而，酒精滥用，AIMD 和中毒或毒性作用的住院人数发生了重大变化。例如，AIMD 涉及的平均季度住院次数在 ICD-10-CM 期间比在 ICD-9-CM 期间高 170.7％。这种增加在很大程度上是由 ICD-10-CM 代码“酒精使用，未指定，伴有未指定的酒精引起的障碍”驱动的。
对涉及酒精相关诊断的住院治疗趋势进行研究的研究人员应考虑 ICD-10-CM 代码系统和编码指南的持续修改如何影响他们的工作。在 ICD-10-CM 转换过程中进行趋势分析的一种可行方法是将诊断代码汇总为更广泛的，具有临床意义的组，包括一个涵盖所有与酒精相关的住院治疗的全球综合组，然后选择诊断分组，以尽量减少两个代码系统之间的不连续性，同时提供有关人群健康这一重要指标的有用信息。
