Shehab Nadine, Ziemba Robert, Campbell Kyle N, Geller Andrew I, Moro Ruth N, Gage Brian F, Budnitz Daniel S, Yang Tsu-Hsuan
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pharmacy and Quality Measurement Division, Health Services Advisory Group, Inc., Tampa, Florida.
Pharmacoepidemiol Drug Saf. 2019 Jul;28(7):951-964. doi: 10.1002/pds.4783. Epub 2019 May 29.
To assess performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code assignments for identifying bleeding events resulting in emergency department visits and hospitalizations among outpatient Medicare beneficiaries prescribed anticoagulants.
Performance of 206 ICD-10-CM code assignments indicative of bleeding, five anticoagulant adverse effect/poisoning codes, and five coagulopathy codes (according to Medicare Parts A and B claims) as assessed among Medicare fee-for-service beneficiaries prescribed anticoagulants between October 1, 2015 and September 30, 2016 (according to Part D claims). Structured medical record review was the gold standard for validating the presence of anticoagulant-related bleeding. Sensitivity was adjusted to correct for partial verification bias due to sampling design.
Based on the study sample of 1166 records (583 cases, 583 controls), 57 of 206 codes yielded the optimal performance for anticoagulant-related bleeding (diagnostic odds ratio, 51; positive predictive value (PPV), 75.7% [95% CI, 72.0%-79.1%]; adjusted sensitivity, 70.0% [95% CI, 63.2%-77.7%]). Codes for intracranial bleeding demonstrated the highest PPV (85.0%) and adjusted sensitivity (91.0%). Bleeding codes in the primary position demonstrated high PPV (86.9%), but low adjusted sensitivity (36.0%). The adjusted sensitivity improved to 69.5% when codes in a secondary position were added. Only one adverse effect/poisoning code was used, appearing in 7.8% of cases and controls (PPV, 71.4% and adjusted sensitivity, 6.8%).
Performance of ICD-10-CM code assignments for bleeding among patients prescribed anticoagulants varied by bleed type and code position. Adverse effect/poisoning codes were not commonly used and would have missed over 90% of anticoagulant-related bleeding cases.
评估国际疾病分类第十次修订本临床修订版（ICD-10-CM）编码在识别接受抗凝治疗的门诊医疗保险受益人中导致急诊就诊和住院的出血事件方面的表现。
在2015年10月1日至2016年9月30日期间接受抗凝治疗的医疗保险按服务收费受益人中（根据D部分索赔），评估206个指示出血的ICD-10-CM编码、五个抗凝药物不良反应/中毒编码和五个凝血病编码（根据医疗保险A部分和B部分索赔）的表现。结构化病历审查是验证抗凝相关出血存在的金标准。敏感性经过调整以纠正由于抽样设计导致的部分验证偏倚。
基于1166份记录的研究样本（583例病例，583例对照），206个编码中有57个在抗凝相关出血方面表现最佳（诊断比值比为51；阳性预测值（PPV）为75.7%[95%CI，72.0%-79.1%]；调整后敏感性为70.0%[95%CI，63.2%-77.7%]）。颅内出血编码的PPV最高（85.0%），调整后敏感性最高（91.0%）。主要位置的出血编码PPV较高（86.9%），但调整后敏感性较低（36.0%）。当添加次要位置的编码时，调整后敏感性提高到69.5%。仅使用了一个不良反应/中毒编码，在7.8%的病例和对照中出现（PPV为71.4%，调整后敏感性为6.8%）。
ICD-10-CM编码在接受抗凝治疗患者中出血方面的表现因出血类型和编码位置而异。不良反应/中毒编码使用不普遍，会漏诊超过90%的抗凝相关出血病例。
