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. 2022 Nov 14;9(12):ofac622.
doi: 10.1093/ofid/ofac622. eCollection 2022 Dec.

Adoption and Trends in Uptake of Updated ICD-10 Codes for Clostridioides difficile-A Retrospective Observational Study

Abhishek Deshpande  1   2 , Yiyun Chen  3 , Eugenia Boye-Codjoe  3 , Engels N Obi  3
Affiliations

Adoption and Trends in Uptake of Updated ICD-10 Codes for Clostridioides difficile-A Retrospective Observational Study

Abhishek Deshpande et al. Open Forum Infect Dis. .

Abstract

Background: In October 2017, the single International Classification of Diseases, Tenth Revision (ICD-10), code for Clostridioides difficile infection (CDI), A04.7, was replaced with 2 codes delineating "recurrent CDI" (rCDI; A04.71) and "nonrecurrent CDI" (nrCDI; A04.72).

Methods: To evaluate and validate use of the updated codes, this retrospective study included inpatient encounters with a CDI-related ICD-10 code from October 2016 to May 2019 in the PINC AITM Healthcare Database (PHD). Encounters after the October 2017 code update were characterized by clinical, facility, and provider variables and whether coding was concordant or discordant to the 8-week recurrence period. Multivariable regression analysis assessed variables associated with concordant coding.

Results: Widespread adoption of the updated CDI codes across PHD hospitals occurred in October 2017. After October 2017, 21 446 CDI-related encounters met sample selection criteria (concordance in 67% of rCDI and 25% of nrCDI encounters). Higher proportions of rCDI- vs nrCDI-coded encounters (P < .05) had emergency room admission, admission by a gastroenterologist or infectious disease specialist, and were prescribed fidaxomicin, bezlotoxumab, or fecal microbiota transfer (FMT), with no significant difference by coding concordance status. Encounters coded concordantly were significantly more likely to be for rCDI (odds ratio [OR], 5.67; 95% CI, 5.32-6.03), a nonelective admission (OR, 1.35-1.69), or prescribed fidaxomicin (OR, 1.11; 95% CI, 1.01-1.23) or FMT (OR, 1.29; 95% CI, 1.17-1.42).

Conclusions: Our study findings suggest no delay in transition to the updated CDI-related codes. Treatment patterns for rCDI vs nrCDI encounters were consistent with Infectious Diseases Society of America guidelines, regardless of concordance status.

Keywords: Clostridioides difficile; ICD-10; concordance; recurrence.

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Conflict of interest statement

Potential conflicts of interest. Yiyun Chen, Eugenia Boye-Codjoe and Engels N. Obi are employees of MSD. Abhishek Deshpande is a consultant for MSD. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Encounter frequency by ICD-10 code type pre– and post–October 2017 code update at hospitals contributing to the PHD. Abbreviations: ICD-10, International Classification of Diseases, Tenth Revision; PHD, PINC AITM Healthcare Database.
See this image and copyright information in PMC

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