Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA.
Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA.
Surgery. 2022 Oct;172(4):1050-1056. doi: 10.1016/j.surg.2022.06.014. Epub 2022 Aug 16.
International Classification of Disease, ninth/tenth revision codes are used to identify patients with appendicitis and classify severity of disease for research and hospital reimbursement. We sought to determine accuracy of International Classification of Disease, ninth/tenth revision codes in classifying appendicitis as uncomplicated versus complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report.
Retrospective review of operative reports and discharge International Classification of Disease, ninth/tenth revision codes for patients ≥18 years old who underwent noninterval, nonincidental appendectomy between January 2012 and December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for International Classification of Disease, ninth/tenth revision codes to classify appendicitis accurately as complicated compared with surgeon description. ICD-9/10 codes and surgeon description were categorized into complicated/uncomplicated based on the American Association for the Surgery of Trauma grading system.
In the study, 1,495 patients with acute appendicitis underwent appendectomy. Per surgeon description, 200 (13%) were complicated and 1,295 (87%) uncomplicated. Compared with surgeon description, discharge International Classification of Disease, ninth/tenth revision codes did not accurately identify complicated appendicitis: sensitivity = 0.68, positive predictive value = 0.77. As a sensitivity analysis, the cohort was stratified by public versus private payers, and the results did not change.
International Classification of Disease, ninth/tenth revision codes do not accurately identify surgeon-described complicated appendicitis. Nearly one-third of the cases of complicated appendicitis were coded as uncomplicated. Such misclassification negatively impacts reimbursement for complicated appendicitis care and could lead to misleading results in research and quality improvement activities that rely on these codes.
国际疾病分类第 9 版/第 10 版代码用于识别阑尾炎患者并对疾病严重程度进行分类，以用于研究和医院报销。我们旨在确定国际疾病分类第 9 版/第 10 版代码在将阑尾炎分类为简单型与复杂型（定义为穿孔、坏疽或脓肿）方面的准确性，与临床金标准相比：手术报告中外科医生对阑尾的描述。
回顾性分析 2012 年 1 月至 2019 年 12 月在一家三级转诊中心接受非间隔、非偶然阑尾切除术的年龄≥18 岁患者的手术报告和出院国际疾病分类第 9 版/第 10 版代码。计算国际疾病分类第 9 版/第 10 版代码用于准确分类阑尾炎为复杂型的敏感性、特异性和阳性预测值，与外科医生描述相比。ICD-9/10 代码和外科医生描述根据美国创伤外科学会分级系统分为复杂/简单型。
在这项研究中，1495 例急性阑尾炎患者接受了阑尾切除术。根据外科医生的描述，200 例（13%）为复杂型，1295 例（87%）为简单型。与外科医生描述相比，出院国际疾病分类第 9 版/第 10 版代码无法准确识别复杂型阑尾炎：敏感性=0.68，阳性预测值=0.77。作为敏感性分析，根据公共或私人支付者对队列进行分层，结果没有改变。
国际疾病分类第 9 版/第 10 版代码无法准确识别外科医生描述的复杂型阑尾炎。近三分之一的复杂型阑尾炎病例被编码为简单型。这种错误分类会对复杂型阑尾炎治疗的报销产生负面影响，并可能导致依赖这些代码的研究和质量改进活动产生误导性结果。
