ICD-10-CM/PCS: potential methodologic strengths and challenges for thoracic surgery researchers and reviewers

Abstract

The recent implementation of the International Classification of Diseases, 10^th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) provides a robust classification of diagnoses and procedures for hospital systems. As researchers begin using ICD-10-CM/PCS for outcomes research from administrative datasets, it is important to understand ICD-10-CM/PCS, as well as the strengths and challenges of these new classifications. In this review, we describe the development of ICD-10-CM/PCS and summarize how it applies specifically to thoracic surgery patients undergoing pulmonary lobectomy, sublobar resection (segmentectomy or wedge resection) and esophagectomy. This myriad of ICD-10-CM/PCS codes presents challenges and questions for thoracic surgery researchers and medical journal reviewers and editors when evaluating thoracic surgical outcomes research utilizing ICD-10-CM/PCS. Additional work is needed to develop consensus guidelines and uniformity for accurate and coherent research methods to utilize ICD-10-CM/PCS in future outcomes research efforts.

Keywords: International Classification of Diseases; clinical coding; outcomes research; research design; thoracic surgical procedures.

Figure 1

Structure of ICD-10-PCS procedure codes using an example for a left upper lobe thoracoscopic lobectomy. ICD-10-PCS, International Classification of Diseases, 10^th Revision, Procedure Coding System.

Figure 2

Structure of ICD-10-PCS procedure codes using an example for an open right upper lung lobe diagnostic wedge (i.e., sublobar) resection. ICD-10-PCS, International Classification of Diseases, 10^th Revision, Procedure Coding System.

Figure 3

Structure of ICD-10-PCS procedure codes using an example for an open esophagectomy of the lower third of the esophagus. ICD-10-PCS, International Classification of Diseases, 10^th Revision, Procedure Coding System.