精准还是陷阱？评估水泥型全髋关节置换术的 ICD-10 编码准确性：一项多中心研究。
Precision or Pitfall? Evaluating the Accuracy of ICD-10 Coding for Cemented Total Hip Arthroplasty: A Multicenter Study.
机构信息
Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
Department of Orthopaedic Surgery, Dignity Health - St. Joseph's Medical Center, Stockton, California.
出版信息
J Bone Joint Surg Am. 2024 Jan 3;106(1):56-61. doi: 10.2106/JBJS.23.00325. Epub 2023 Nov 16.
BACKGROUND
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedure Coding System (ICD-10-PCS) was adopted in the U.S. in 2015. Proponents of the ICD-10-PCS have stated that its granularity allows for a more accurate representation of the types of procedures performed by including laterality, joint designation, and more detailed procedural data. However, other researchers have expressed concern that the increased number of codes adds further complexity that leads to inaccurate and inconsistent coding, rendering registry and research data based on ICD-10-PCS codes invalid and inaccurate. We aimed to determine the accuracy of the ICD-10-PCS for identifying cemented fixation in primary total hip arthroplasty (THA).
METHODS
We retrospectively reviewed all cemented primary THAs performed at 4 geographically diverse, academic medical centers between October 2015 and October 2020. Cemented fixation was identified from the ICD-10-PCS coding for each procedure. The accuracy of an ICD-10-PCS code relative to the surgical record was determined by postoperative radiograph and chart review, and cross-referencing with institution-level coding published by the American Joint Replacement Registry (AJRR) was also performed.
RESULTS
A total of 552 cemented THA cases were identified within the study period, of which 452 (81.9%) were correctly coded as cemented with the ICD-10-PCS. The proportion of cases that were correctly coded was 187 of 260 (72%) at Institution A, 158 of 185 (85%) at Institution B, 35 of 35 (100%) at Institution C, and 72 of 72 (100%) at Institution D. Of the 480 identified cemented THA cases at 3 of the 4 institutions, 403 (84%) were correctly reported as cemented to the AJRR (Institution A, 185 of 260 cases [71%]; Institution B, 185 of 185 [100%]; and Institution C, 33 of 35 [94%]). Lastly, of these 480 identified cemented THA cases, 317 (66%) were both correctly coded with the ICD-10-PCS and correctly reported as cemented to the AJRR.
CONCLUSIONS
Our findings revealed existing discrepancies within multiple institutional data sets, which may lead to inaccurate reporting by the AJRR and other registries that rely on ICD-10-PCS coding. Caution should be exercised when utilizing ICD-10 procedural data to evaluate specific details from administrative claims databases as these inaccuracies present inherent challenges to data validity and interpretation.
背景
国际疾病分类第十次修订本手术操作分类（ICD-10-PCS）于 2015 年在美国采用。ICD-10-PCS 的支持者表示，其粒度允许更准确地表示所执行的手术类型，包括侧别、关节指定和更详细的手术数据。然而，其他研究人员则表示担心，代码数量的增加增加了进一步的复杂性，导致编码不准确和不一致，从而使基于 ICD-10-PCS 代码的登记处和研究数据无效和不准确。我们旨在确定 ICD-10-PCS 在识别原发性全髋关节置换术（THA）中的骨水泥固定中的准确性。
方法
我们回顾性分析了 2015 年 10 月至 2020 年 10 月期间在 4 个地理位置不同的学术医疗中心进行的所有骨水泥固定原发性 THA。通过每个手术的 ICD-10-PCS 编码来确定骨水泥固定。通过术后 X 线片和图表审查以及与美国关节置换登记处（AJRR）公布的机构级别编码交叉引用来确定 ICD-10-PCS 代码相对于手术记录的准确性。
结果
在研究期间共确定了 552 例骨水泥固定 THA 病例，其中 452 例（81.9%）通过 ICD-10-PCS 正确编码为骨水泥固定。正确编码的病例比例在机构 A 为 260 例中的 187 例（72%），机构 B 为 185 例中的 158 例（85%），机构 C 为 35 例中的 35 例（100%），机构 D 为 72 例中的 72 例（100%）。在 4 个机构中的 3 个机构确定的 480 例骨水泥固定 THA 病例中，403 例（84%）正确报告为 AJRR 中的骨水泥固定（机构 A，260 例中的 185 例[71%]；机构 B，185 例中的 185 例[100%]；机构 C，35 例中的 35 例[94%]）。最后，在这 480 例确定的骨水泥固定 THA 病例中，317 例（66%）同时通过 ICD-10-PCS 正确编码并正确报告为 AJRR 中的骨水泥固定。
结论
我们的研究结果揭示了多个机构数据集内存在的差异，这可能导致 AJRR 和其他依赖 ICD-10-PCS 编码的登记处报告不准确。在利用 ICD-10 手术数据评估行政索赔数据库中的具体细节时，应谨慎行事，因为这些不准确会对数据有效性和解释造成固有挑战。
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