Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Movig, Kris L. L.; Leufkens, H.G.M.; Lenderink, A.W.; Egberts, Toine C. G.

doi:10.1016/s0895-4356(03)00006-4

Cited by 75 publications

(47 citation statements)

References 23 publications

(34 reference statements)

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“…The disorder was more frequently diagnosed in the case of severe forms of hyponatraemia, but still barely 30% of hyponatraemia with < 115 mmoL/L were reported and coded in accordance with ICD requirements [17]. This observation has also been confirmed by the present study.…”

Section: Discussionsupporting

confidence: 86%

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Zarzecka

Kubicki²,

Kozielski³

2013

Advances in Respiratory Medicine

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Introduction: It is known from clinical practice that data concerning plasma sodium concentration and its influence on patient prognosis are underestimated. The aim of this study was the evaluation of the prevalence and influence of hyponatraemia on prognosis in patients with lung diseases, particularly with lung cancer. Material and methods: Retrospective analysis of data obtained from a single Pulmonary Department was performed. A total of 449 patients divided in two groups, were analysed. The first group consisted of all lung cancer patients (n = 290) hospitalized in the analysed period. The second group included patients with hyponatraemia but without diagnosed lung cancer (n = 159). The prevalence of hyponatraemia, including severity (mild, moderate or severe), was evaluated. Histological types of lung cancer as well as comorbidities were taken into account. Results: Hyponatraemia was found in 46.9% of patients with lung cancer, including mild (serum sodium 135-130 mEq/L), moderate (129-125 mEq/L) and severe hyponatraemia (< 125 mEq/L) in 66.9%, 25% and 8.1, respectively. In patients without lung cancer and with recognized hyponatraemia, mild, moderate and severe hyponatraemia were found in 81.8%, 13.2% and 5%, respectively (mainly in obstructive and interstitial lung diseases). Hyponatraemia was observed in 52.6% of patients with non-small cell lung cancer (NSCLC) and in 45.2% of patients with small cell lung cancer (SCLC). There was no statistical significance in prevalence of hyponatraemia between histological types of lung cancer. In patients with lung cancer and hyponatraemia compared to patients with lung cancer but without hyponatraemia, a significant increase of in-hospital mortality was found (28.7% vs. 7.8%, respectively) p < 0.001. Conclusions: Hyponatraemia was a common abnormality found in approximately 50% of lung cancer patients. Hyponatraemia was a significant prognostic factor associated with poor prognosis.

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Section: Discussionsupporting

confidence: 86%

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Zarzecka

Kubicki²,

Kozielski³

2013

Advances in Respiratory Medicine

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“…5 Incomplete and/or inadequate use of ICD-9 codes for clinical diagnoses on hospital discharge could lead to an over-or underestimation of disease prevalence. 5,8 Unreliable or inaccurate clinical coding has major implications for accurate reimbursement. The development of prospective payment systems based on a classification framework which is closely linked with the ICD makes the importance of clinical coding imperative for some hospitals, 7,[9][10] where hospital revenue will depend to a large extent on the validity of clinical coding and diagnostic information.…”

mentioning

confidence: 99%

A pilot study of the impact of an educational intervention aimed at improving medical record documentation

Farzandipour¹,

Meidani²,

F³

et al. 2013

J R Coll Physicians Edinb

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“…It has been shown that only a small percentage of patients with hyponatremia receive an ICD-9-CM diagnosis code for hyponatremia 23 ; therefore, we used outpatient laboratory test results to identify serum sodium values. Furthermore, because hypernatremia is also associated with higher mortality and can be an indicator of infection, 14,15,24 we expected patients with hypernatremia to incur higher costs than patients with normal serum sodium.…”

Section: Discussionmentioning

confidence: 99%

Medical Costs of Abnormal Serum Sodium Levels

Shea

Hammill

Curtis

et al. 2008

Journal of the American Society of Nephrology

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An abnormal serum sodium level is the most common electrolyte disorder in the United States and can have a significant impact on morbidity and mortality. The direct medical costs of abnormal serum sodium levels are not well understood. The impact of hyponatremia and hypernatremia on 6-mo and 1-yr direct medical costs was examined by analyzing data from the Integrated HealthCare Information Services National Managed Care Benchmark Database. During the period analyzed, there were 1274 patients (0.8%) with hyponatremia (serum sodium Ͻ135 mmol/L), 162,829 (97.3%) with normal serum sodium levels, and 3196 (1.9%) with hypernatremia (Ͼ145 mmol/L). Controlling for age, sex, region, and comorbidities, hyponatremia was a significant independent predictor of costs at 6 mo (41.2% increase in costs; 95% confidence interval, 30.3% to 53.0%) and at 1 yr (45.7% increase; 95% confidence interval, 34.2% to 58.2%). Costs associated with hypernatremia were not significantly different from those incurred by patients with normal serum sodium. In conclusion, hyponatremia is a significant independent predictor of 6-mo and 1-yr direct medical costs. Abnormal serum sodium is the most common electrolyte disorder in the United States. Estimates of the prevalence of hyponatremia range from 1% in general acute care populations 1,2 to 18% among elderly nursing home residents 3 and nearly 30% in intensive care settings. 4 Hypernatremia is less common, ranging from 0.3% to 8.9% in hospitalized adults. 5,6 Mild, chronic hyponatremia is often asymptomatic; neurologic and gastrointestinal symptoms generally increase as the condition worsens. 7 Hypernatremia may also be asymptomatic until it exceeds a certain threshold, at which point central nervous system dysfunction develops. 8 However, hyponatremia and hypernatremia of all severity levels have significant effects on morbidity and mortality.In a cohort of 4123 elderly patients, Terzian et al. 9 studied the relationship between hyponatremia at the time of hospital admission and treatment outcomes. After adjustment for age, sex, length of stay, and several clinical factors, hyponatremia was a significant independent predictor of mortality.Similar results have been found for patients with heart failure and myocardial infarction. In a study of patients with suspected congestive heart failure at admission, serum sodium Յ135 mmol/L was independently associated with major complications during hospitalization, greater length of stay, higher hospital costs, and greater inpatient mortality. 10 In a more recent trial, patients hospitalized for worsening heart failure with hyponatremia at admission (serum sodium Յ135 mmol/L) experienced significantly greater in-hospital and 60-d mortality, compared with patients with normal or high serum sodium. 11 In patients with acute ST-

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Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia

Cited by 75 publications

References 23 publications

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

Hyponatraemia—Evaluation of Prevalence in Patients Hospitalized in the Pulmonary Department and Prognostic Significance in Lung Cancer Patients

A pilot study of the impact of an educational intervention aimed at improving medical record documentation

Medical Costs of Abnormal Serum Sodium Levels

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