Iyer Sneha, Patel Nisha, Sanfilippo Eric, Dellavalle Robert P, Silverberg Jonathan I
Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA.
Arch Dermatol Res. 2023 May;315(4):879-884. doi: 10.1007/s00403-022-02435-y. Epub 2022 Nov 12.
Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.
在医疗保健理赔数据库中，关于国际疾病分类第十次修订本临床修正版（ICD - 10 - CM）编码用于特应性皮炎（AD）的有效性知之甚少。我们评估了ICD - 10 - CM编码用于识别成年AD患者的有效性。查询了一家大型都市三级医疗中心的医疗保健理赔数据库中L20.x和L30.9的诊断编码。对病历进行了人口统计学、合并症、哈尼芬和拉伊卡（H - R）以及英国工作组（UKWP）标准的审查。计算了敏感性、特异性和阳性预测值（PPV）。总体而言，共识别出833名患者出现了上述至少一次AD的ICD - 10编码。以H - R和UKWP标准作为AD的金标准定义，任何上述L20.x ICD - 10编码的PPV分别为39.1%和51.4%，敏感性分别为98.1%和97.4%。L20.82的PPV分别为25%和50%；L20.84的PPV分别为66.7%和100%；L20.89的PPV分别为37.5%和62.5%；L20.9的PPV分别为60.1%和51.4%。当病例定义将ICD - 10编码与哮喘或花粉症、食物过敏和过敏性鼻炎的共存ICD - 10编码相结合时，PPV通常会增加，皮肤科医生对AD的ICD - 10编码进行编码时PPV增加程度较小。在符合所有这些标准的患者中，基于H - R和UKWP标准，PPV分别增至100%和80%，但敏感性分别降至83.3%和80.0%。总之，仅用于AD的ICD - 10 - CM编码在医疗保健理赔数据库中识别AD的PPV较差。AD与合并的特应性疾病的联合ICD - 10编码提高了PPV和分类的特异性，但以敏感性为代价。
