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. 2021 Jan 5;5(4):e10257.
doi: 10.1002/lrh2.10257. eCollection 2021 Oct.

Assessing the utility and accuracy of ICD10-CM non-traumatic subarachnoid hemorrhage codes for intracranial aneurysm research

Christopher Roark  1 , Melissa P Wilson  2 , Sheila Kubes  1 , David Mayer  2 , Laura K Wiley  2
Affiliations

Assessing the utility and accuracy of ICD10-CM non-traumatic subarachnoid hemorrhage codes for intracranial aneurysm research

Christopher Roark et al. Learn Health Syst. .

Abstract

Background: The 10th revision of International Classification of Disease, Clinical Modification (ICD10-CM) increased the number of codes to identify non-traumatic subarachnoid hemorrhage from 1 to 22. ICD10-CM codes are able to specify the location of aneurysms causing subarachnoid hemorrhage (aSAH); however, it is not clear how frequently or accurately these codes are being used in practice.

Objective: To systematically evaluate the usage and accuracy of location-specific ICD10-CM codes for aSAH.

Methods: We extracted all uses of ICD10-CM codes for non-traumatic subarachnoid hemorrhage (I60.x) during the first 3 years following the implementation of ICD10-CM from the billing module of the electronic health record (EHR) for UCHealth. For those codes that specified aSAH location (I60.0-I60.6), EHR documentation was reviewed to determine whether there was an active aSAH, any patient history of aSAH, or unruptured intracranial aneurysm/s and the locations of those outcomes.

Results: Between 1 October 2015 and 30 September 2018, there were 3119 instances of non-traumatic subarachnoid hemorrhage ICD10-CM codes (I60.00-I60.9), of which 297 (9.5%) code instances identified aSAH location (I60.0-I60.6). The usage of location-specific codes increased from 5.7% in 2015 to 11.2% in 2018. These codes accurately identified current aSAH (64%), any patient history of aSAH (84%), and any patient history of intracranial aneurysm (87%). The accuracy of identified outcome location was 53% in current aSAH, 72% for any history of aSAH, and 76% for any history of an intracranial aneurysm.

Conclusions: Researchers should use ICD10-CM codes with caution when attempting to detect active aSAH and/or aneurysm location.

Keywords: administrative databases; electronic health records; intracranial aneurysm; subarachnoid hemorrhage.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Frequency of ICD10‐CM codes that specify location of non‐traumatic subarachnoid hemorrhage. The usage of each ICD10‐CM code that specifies aSAH location (ie, I60.0‐I60.6) is provided as a percent of the total code instances (light blue) or unique patients (dark blue)
FIGURE 2
FIGURE 2
Accuracy of ICD10‐CM that specify location of non‐traumatic subarachnoid hemorrhage to identify current aneurysmal subarachnoid hemorrhage, any history of subarachnoid hemorrhage, or any history of intracranial aneurysm. The total number of code instances that correctly identified both the outcome (current aSAH—left, history of aSAH—middle, history of intracranial aneurysm—right) and artery is displayed in green. The total number of code instances that correctly identified the outcome but not the correct artery is displayed in orange. The total number of code instances that did not correctly identify the outcome is displayed in red
FIGURE 3
FIGURE 3
Usage frequency of ICD10‐CM codes for non‐traumatic subarachnoid hemorrhage across 1 October 2015 to 30 September 2018. The monthly total number of ICD10‐CM code instances for non‐traumatic subarachnoid hemorrhage (I60.0‐I60.9) across the study period. The count of codes that specified aSAH location (I60.0‐I60.6) are shown in light blue, while those that did not specify location (I60.7‐I60.9) are shown in yellow
FIGURE 4
FIGURE 4
Accuracy of ICD10‐CM codes that specify location of non‐traumatic subarachnoid hemorrhage to detect any history of intracranial aneurysm across 1 October 2015 to 30 September 2018. The monthly total number of ICD10‐CM code instances that specify location of non‐traumatic subarachnoid hemorrhage (I60.0‐I60.6) across the study period. The total number of code instances that correctly identified both the history of an intracranial aneurysm (ruptured or unruptured) and the artery location is displayed in green. The total number of code instances that correctly identified a history of intracranial aneurysm but not the correct artery is displayed in orange. The total number of code instances that did not correctly identify a history of intracranial aneurysm is displayed in red
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