Lygrisse Katherine A, Roof Mackenzie A, Keitel Lauren N, Callaghan John J, Schwarzkopf Ran, Bedard Nicholas A
NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY.
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
J Arthroplasty. 2020 Oct;35(10):2960-2965.e3. doi: 10.1016/j.arth.2020.05.013. Epub 2020 May 12.
The International Statistical Classification of Diseases, 10th Revision (ICD-10), was adopted by the United States on October 1, 2015 and expanded coding from 3800 codes with the International Statistical Classification of Diseases, Ninth Revision, procedure code system (ICD-9-PCS) to 73,000. The increase in number of codes was designed to create more accurate representations of procedures like revision total hip arthroplasties (rTHAs). However, many worry that the increased complexity leads to more inaccurate coding. The purpose of this study is to determine the accuracy of ICD-10-PCS coding for rTHA and discuss the implications on registry data.
The rTHA databases at 2 large, academic medical centers were retrospectively reviewed for all rTHAs between October 1, 2015 and July 3, 2019. The laterality and specific revised components were recorded and compared with the ICD-10-PCS codes used for each procedure. The accuracy of ICD-10-PCS codes relative to the surgical record was determined using coding guidelines published by the American Joint Replacement Registry (AJRR).
Overall, 895 cases were reviewed. Replacement coding was 22% accurate (195 of 895). For removal and replacement coding, accuracy dropped to 17% (152 of 895). All procedures had at least 1 rTHA trigger code that would signify correctly to AJRR that an rTHA occurred.
In this study, the percent of correctly coded rTHA was low. All rTHA procedures had at least 1 AJRR trigger code; therefore, an rTHA would have been appropriately captured by AJRR. But these inaccuracies should make one pause when using ICD-10-PCS procedural data to try to evaluate specific rTHA details from administrative claims databases and ward against expanding ICD-10-PCS as a means to collect implant survival and registry data.
《国际疾病分类》第十次修订版（ICD - 10）于2015年10月1日被美国采用，编码数量从《国际疾病分类》第九次修订版程序编码系统（ICD - 9 - PCS）的3800个扩展到73000个。编码数量的增加旨在更准确地描述诸如全髋关节翻修术（rTHA）等手术。然而，许多人担心复杂性的增加会导致编码更不准确。本研究的目的是确定ICD - 10 - PCS对rTHA编码的准确性，并讨论其对登记数据的影响。
对2家大型学术医疗中心的rTHA数据库进行回顾性研究，纳入2015年10月1日至2019年7月3日期间的所有rTHA病例。记录手术部位和具体的翻修部件，并与每个手术所使用的ICD - 10 - PCS编码进行比较。根据美国关节置换登记处（AJRR）发布的编码指南，确定ICD - 10 - PCS编码相对于手术记录的准确性。
总体而言，共审查了895例病例。置换编码的准确率为22%（895例中的195例）。对于取出和置换编码，准确率降至17%（895例中的152例）。所有手术至少有1个rTHA触发编码，可向AJRR正确表明发生了rTHA。
在本研究中，rTHA编码正确的百分比很低。所有rTHA手术至少有1个AJRR触发编码；因此，AJRR能够适当地捕捉到rTHA。但是，当使用ICD - 10 - PCS程序数据试图从行政索赔数据库评估特定rTHA细节以及在考虑扩大ICD - 10 - PCS作为收集植入物存活率和登记数据的手段时，这些不准确之处应引起人们的警惕。
