Accuracy of ICD-10-CM claims-based definitions for epilepsy and seizure type

Abstract

Objective: To evaluate the accuracy of ICD-10-CM claims-based definitions for epilepsy and classifying seizure types in the outpatient setting. Methods:We reviewed electronic health records (EHR) for a cohort of adults aged 18+ years seen by six neurologists who had an outpatient visit at a level 4 epilepsy center between 01/2019-09/2019. The neurologists used a standardized documentation template to capture the diagnosis of epilepsy (yes/no/unsure), seizure type (focal/generalized/unknown), and seizure frequency in the EHR. Using linked ICD-10-CM codes assigned by the provider, we assessed the accuracy of claims-based definitions for epilepsy, focal seizure type, and generalized seizure type against the reference-standard EHR documentation by estimating sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).

Multiple sclerosis is associated with higher comorbidity and health care resource use: A population‐based, case–control study in a western Mediterranean region

“…We did not perform sensitivity analyses using alternative codes, which is a limitation. However, the ICD‐10 codes used in this study have been shown to have high rates of agreement with clinical records, at least for the comorbidities for which we found significant differences in risk [69–73]. We did not assess and control for the number or frequency of visits with the PCP, which might be a source of ascertainment bias, and could explain in part the increased frequency of comorbidities in younger MS patients.…”

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

“…Similar to prior work, [ 28 , 29 ] to identify prevalent treated epilepsy, we required at least one International Classification of Disease, Clinical Modification (ICD-CM) epilepsy/convulsion code (ICD-9 before October 1, 2015: 345.xx/780.3x; ICD-10 after October 1, 2015: G40/R56) plus at least one ASM fill in every year 2014–2016 (hence, appearance of at least three ICD codes, and sustained ASM treatment, over time; ASMs listed in Supplemental Table 1 ). Combining codes plus ASM fills in Medicare identified patients with epilepsy with an area under the curve 0.93, sensitivity 88%, and specificity 98% compared with reference gold standards of electronic medical records-based diagnosis by a blinded experienced neurologist using current International League Against Epilepsy guidelines [ 30 ].…”

“…We captured predictors such as those above, based on literature review and study team expert consensus possibly related to nonadherence [ 28 ] and discontinuation [ 40 ]. These included demographics (age, sex, race, Medicaid dual eligibility due to low income, rural ZIP code, [ 47 ] geographic region, reason for Medicare entitlement), clinical characteristics (dementia, depression, [ 48 ] Charlson comorbidity index, [ 49 , 50 ] number of ASMs, total number of medications, neurologist visit in 2015, yearly office visits for epilepsy), and epileptogenic neurological conditions in 2014–2015 (stroke, traumatic brain injury, intracranial hemorrhage, central nervous system tumor, meningoencephalitis, cardiac arrest; Supplemental Table 2 ), focal or generalized epilepsy, [ 29 ] and refractory epilepsy, [ 51 ] in 2014–2015.…”

Drivers of US health care spending for persons with seizures and/or epilepsies, 2010–2018

“…The health care costs attributable to evaluation and management of epilepsy vary based on seizure types and levels of seizure control 39 . Future studies may use claims‐based approaches for defining seizure control and stratifying by epilepsy subgroups 40 . Our study could not differentiate patients with prevalent versus incident epilepsy, or well‐controlled epilepsy versus refractory epilepsy.…”