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Comparative Study
. 2020 Sep;7(1):e000485.
doi: 10.1136/bmjgast-2020-000485.

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

Kelly L Hayward  1   2 , Amy L Johnson  1   2 , Benjamin J Mckillen  1   2 , Niall T Burke  1 , Vikas Bansal  1 , Leigh U Horsfall  1   2 , Gunter Hartel  3 , Chris Moser  4 , Elizabeth E Powell #  1   2 , Patricia C Valery #  5   6
Affiliations
Comparative Study

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

Kelly L Hayward et al. BMJ Open Gastroenterol. 2020 Sep.

Abstract

Objective: The utility of International Classification of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This study explores the accuracy and limitations of the Australian Modification of the 10th revision of ICD (ICD-10-AM) to detect the presence of cirrhosis and a subset of key complications for the purpose of future large-scale epidemiological research and healthcare studies.

Design/method: ICD-10-AM codes in a random sample of 540 admitted patient encounters at a major Australian tertiary hospital were compared with data abstracted from patients' medical records by four blinded clinicians. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, positive predictive value (PPV), negative predictive value and Cohen's kappa coefficient (κ).

Results: The PPVs for 'grouped cirrhosis' codes (0.96), hepatocellular carcinoma (0.97) ascites (0.97) and 'grouped varices' (0.95) were good (κ all >0.60). However, codes under-detected the prevalence of cirrhosis, ascites and varices (sensitivity 81.4%, 61.9% and 61.3%, respectively). Overall accuracy was lower for spontaneous bacterial peritonitis ('grouped' PPV 0.75; κ 0.73) and the poorest for encephalopathy ('grouped' PPV 0.55; κ 0.21). To optimise detection of cirrhosis-related encounters, an ICD-10-AM code algorithm was constructed and validated in an independent cohort of 116 patients with known cirrhosis.

Conclusion: Multiple ICD-10-AM codes should be considered when using administrative databases to study the burden of cirrhosis and its complications in Australia, to avoid underestimation of the prevalence, morbidity, mortality and related resource utilisation from this burgeoning chronic disease.

Keywords: ascites; epidemiology; health service research; hepatic encephalopathy; peritonitis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Heatmap depicting prevalence and clustering of select ICD-10-AM codes in 116 unplanned liver-related encounters (A), 111 elective day admissions (B) and 94 ‘other’ encounters (C). Columns represent individual encounters. K* included at least one of: K70.3, K74.4, K74.5, K74.6, K70.4, K72.9, K76.6; I* included at least one of: I85.0, I85.9, I98.3, I98.2, I86.4. ICD-10-AM, Australian modification of the 10th revision of International Classification of Diseases.
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