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Assessment of ICD‐10‐CM code assignment validity for case finding of outpatient anticoagulant‐related bleeding among Medicare beneficiaries
Author(s) -
Shehab Nadine,
Ziemba Robert,
Campbell Kyle N.,
Geller Andrew I.,
Moro Ruth N.,
Gage Brian F.,
Budnitz Daniel S.,
Yang TsuHsuan
Publication year - 2019
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4783
Subject(s) - medicine , diagnosis code , gold standard (test) , emergency medicine , adverse effect , medical record , icd 10 , odds ratio , population , psychiatry , environmental health
Purpose To assess performance of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) code assignments for identifying bleeding events resulting in emergency department visits and hospitalizations among outpatient Medicare beneficiaries prescribed anticoagulants. Methods Performance of 206 ICD‐10‐CM code assignments indicative of bleeding, five anticoagulant adverse effect/poisoning codes, and five coagulopathy codes (according to Medicare Parts A and B claims) as assessed among Medicare fee‐for‐service beneficiaries prescribed anticoagulants between October 1, 2015 and September 30, 2016 (according to Part D claims). Structured medical record review was the gold standard for validating the presence of anticoagulant‐related bleeding. Sensitivity was adjusted to correct for partial verification bias due to sampling design. Results Based on the study sample of 1166 records (583 cases, 583 controls), 57 of 206 codes yielded the optimal performance for anticoagulant‐related bleeding (diagnostic odds ratio, 51; positive predictive value (PPV), 75.7% [95% CI, 72.0%‐79.1%]; adjusted sensitivity, 70.0% [95% CI, 63.2%‐77.7%]). Codes for intracranial bleeding demonstrated the highest PPV (85.0%) and adjusted sensitivity (91.0%). Bleeding codes in the primary position demonstrated high PPV (86.9%), but low adjusted sensitivity (36.0%). The adjusted sensitivity improved to 69.5% when codes in a secondary position were added. Only one adverse effect/poisoning code was used, appearing in 7.8% of cases and controls (PPV, 71.4% and adjusted sensitivity, 6.8%). Conclusions Performance of ICD‐10‐CM code assignments for bleeding among patients prescribed anticoagulants varied by bleed type and code position. Adverse effect/poisoning codes were not commonly used and would have missed over 90% of anticoagulant‐related bleeding cases.