LO013: Can you trust administrative data? Accuracy of ICD-10 codes for diagnosis of pulmonary embolism

Abstract

Introduction: Administrative data is a useful tool for research and quality improvement; however, the validity of research findings based on these data depends on their reliability. Diagnoses are recorded using diagnostic codes, as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Several groups have reported coding errors associated with ICD-10 assignments to patient diagnoses; these errors have serious implications for research, quality improvement, and policymaking. As part of a quality improvement project targeting emergency department (ED) diagnostic appropriateness for pulmonary embolism (PE), we sought to validate the accuracy of ICD-10 codes for studying ED patients diagnosed with PE. Methods: Hospital administrative data for adult patients (age ≥18 years) with an ICD-10 code for PE (I26.0 and I26.9) were obtained from the records of four urban EDs between July 2013 to January 2015. A review of medical records and imaging reports was used to confirm the diagnosis of PE. In the case of discrepancy between ICD-10 coding and chart review, the diagnosis obtained from chart review was considered correct. The physicians’ discharge notes in the administrative database were also searched using ‘pulmonary embolism’ and ‘PE’, and patients who were diagnosed with PE but not coded as PE were identified. Coding discrepancies were quantified and described. Results: 1,453 ED patients had a PE ICD-10 code during our study period. 257 (17.7%) of these patients’ diagnoses were improperly coded. 211 patients assigned an ICD-10 PE code had ED discharge diagnoses of ‘rule-out PE’ or ‘query PE’. 64 other patients were miscoded as having a PE and should have been assigned an alternate code, such as chest pain, hypoxia, or dyspnea. The physician did not include a discharge diagnosis in 4 of the 64 miscoded patients; however, triage and physician assessment notes indicated no suspicion of PE. Furthermore, 117 patients who had an ED discharge diagnosis of PE were not assigned a PE code, meaning that 8.91% of true PEs were missed by using ICD-10 codes alone. Thus, 1,313 ED patients truly had a PE. Conclusion: Our work suggests the need for more accuracy in ICD-10 coding of ED diagnoses of PE. Caution should be exercised when using administrative data for studying PE, and validation of the accuracy of ICD-10 coding prior to research use is recommended.