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. 2021 Jan 25;8(1):4.
doi: 10.1186/s40621-021-00298-x.

Impact of ICD-9-CM to ICD-10-CM coding transition on trauma hospitalization trends among young adults in 12 states

Yuri V Sebastião #  1   2 , Gregory A Metzger #  1   3 , Deena J Chisolm  1   4   5   6 , Henry Xiang  5   7   8 , Jennifer N Cooper  9   10   11
Affiliations

Impact of ICD-9-CM to ICD-10-CM coding transition on trauma hospitalization trends among young adults in 12 states

Yuri V Sebastião et al. Inj Epidemiol. .

Abstract

Background: We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states.

Methods: Interrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19-44 years in 2011-2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury.

Results: The transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (- 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9-15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement.

Conclusions: The U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data.

Level of evidence: II (Interrupted Time Series).

Keywords: External cause of injury; ICD-10-CM; Injury severity score; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Effects of the transition to ICD-10-CM on ECOI completion for traumatic injury related hospitalizations among young adults. The immediate drop in ECOI completion following the transition to the ICD-10-CM coding guidelines in October 2015 remained beyond the first month after the transition (right plot excludes Oct. 2015 data point). There was no change in the pre- and post-transition trend
Fig. 2
Fig. 2
Effects of the transition to ICD-10-CM on traumatic injury related hospitalizations among young adults by coded intent of injury. The percentage of hospitalizations for traumatic injury among young adults by injury intent across 12 states from January 2011 to December 2017. From top left to bottom right: Unintentional, Intentional Self-Harm, Assault, Undetermined
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