基于 ICD-10-CM 索赔的癫痫和发作类型定义的准确性。
Accuracy of ICD-10-CM claims-based definitions for epilepsy and seizure type.
机构信息
Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Research and New Therapies, Epilepsy Foundation, 8301 Professional Place West, Suite 230, Landover, MD, 20785, USA.
出版信息
Epilepsy Res. 2020 Oct;166:106414. doi: 10.1016/j.eplepsyres.2020.106414. Epub 2020 Jul 11.
OBJECTIVE
To evaluate the accuracy of ICD-10-CM claims-based definitions for epilepsy and classifying seizure types in the outpatient setting.
METHODS
We reviewed electronic health records (EHR) for a cohort of adults aged 18+ years seen by six neurologists who had an outpatient visit at a level 4 epilepsy center between 01/2019-09/2019. The neurologists used a standardized documentation template to capture the diagnosis of epilepsy (yes/no/unsure), seizure type (focal/generalized/unknown), and seizure frequency in the EHR. Using linked ICD-10-CM codes assigned by the provider, we assessed the accuracy of claims-based definitions for epilepsy, focal seizure type, and generalized seizure type against the reference-standard EHR documentation by estimating sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).
RESULTS
There were 673 eligible outpatient encounters. After review of EHRs for standardized documentation, an analytic sample consisted of 520 encounters representing 402 unique patients. In the EHR documentation, 93.5 % (n = 486/520) of encounters were with patients with a diagnosis of epilepsy. Of those, 66.0 % (n = 321/486) had ≥1 focal seizure, 41.6 % (n = 202/486) had ≥1 generalized seizure, and 7% (n = 34/486) had ≥1 unknown seizure. An ICD-10-CM definition for epilepsy (i.e., ICD-10 G40.X) achieved Sn = 84.4 % (95 % CI 80.8-87.5%), Sp = 79.4 % (95 % CI 62.1-91.3%), PPV = 98.3 % (95 % CI 96.6-99.3%), and NPV = 26.2 % (95 % CI 18.0-35.8%). The classification of focal vs generalized/unknown seizures achieved Sn = 69.8 % (95 % CI 64.4-74.8%), Sp = 79.4 % (95 % CI 72.4-85.3%), PPV = 86.8 % (95 % CI 82.1-90.7%), and NPV = 57.5 % (95 % CI 50.8-64.0%).
CONCLUSIONS
Claims-based definitions using groups of ICD-10-CM codes assigned by neurologists in routine outpatient clinic visits at a level 4 epilepsy center performed well in discriminating between patients with and without a diagnosis of epilepsy and between seizure types.
目的
评估基于 ICD-10-CM 索赔的癫痫定义和分类门诊发作类型的准确性。
方法
我们回顾了在 2019 年 1 月至 2019 年 9 月期间，在一家四级癫痫中心就诊的六名神经科医生的门诊就诊的成年人队列的电子健康记录 (EHR)。神经科医生使用标准化的文档模板来捕获 EHR 中的癫痫（是/否/不确定）、发作类型（局灶性/全面性/未知）和发作频率的诊断。使用提供者分配的链接 ICD-10-CM 代码，我们通过估计敏感性 (Sn)、特异性 (Sp)、阳性预测值 (PPV) 和阴性预测值 (NPV)，评估基于索赔的癫痫、局灶性发作类型和全面性发作类型的定义与参考标准 EHR 文档的准确性。
结果
共有 673 例符合条件的门诊就诊。在对 EHR 进行标准化记录审查后，分析样本包括 520 例就诊，代表 402 例独特患者。在 EHR 记录中，93.5%（n=486/520）的就诊患者被诊断为癫痫。其中，66.0%（n=321/486）有≥1 次局灶性发作，41.6%（n=202/486）有≥1 次全面性发作，7%（n=34/486）有≥1 次未知发作。ICD-10-CM 癫痫定义（即 ICD-10 G40.X）的 Sn 为 84.4%（95%CI 80.8-87.5%），Sp 为 79.4%（95%CI 62.1-91.3%），PPV 为 98.3%（95%CI 96.6-99.3%），NPV 为 26.2%（95%CI 18.0-35.8%）。局灶性与全面性/未知发作的分类的 Sn 为 69.8%（95%CI 64.4-74.8%），Sp 为 79.4%（95%CI 72.4-85.3%），PPV 为 86.8%（95%CI 82.1-90.7%），NPV 为 57.5%（95%CI 50.8-64.0%）。
结论
在四级癫痫中心的常规门诊就诊中，使用神经科医生分配的 ICD-10-CM 代码组的基于索赔的定义在区分有和无癫痫诊断的患者以及区分发作类型方面表现良好。
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