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. 2025 Feb;23(2):556-564.
doi: 10.1016/j.jtha.2024.10.013. Epub 2024 Nov 4.

Validating International Classification of Diseases Code 10th Revision algorithms for accurate identification of pulmonary embolism

Behnood Bikdeli  1 , Candrika D Khairani  2 , Antoine Bejjani  3 , Ying-Chih Lo  4 , Shiwani Mahajan  5 , César Caraballo  6 , Jose Victor Jimenez  7 , Darsiya Krishnathasan  2 , Mehrdad Zarghami  8 , Sina Rashedi  2 , David Jimenez  9 , Stefano Barco  10 , Eric A Secemsky  11 , Frederikus A Klok  12 , Andetta R Hunsaker  13 , Ayaz Aghayev  13 , Alfonso Muriel  14 , Mohamad A Hussain  15 , Abena Appah-Sampong  15 , Yuan Lu  7 , Zhenqiu Lin  7 , Hamid Mojibian  16 , Sanjay Aneja  17 , Rohan Khera  6 , Stavros Konstantinides  18 , Samuel Z Goldhaber  19 , Liqin Wang  4 , Li Zhou  4 , Manuel Monreal  20 , Gregory Piazza  19 , Harlan M Krumholz  21 ; PE-EHR+ Investigators
Affiliations

Validating International Classification of Diseases Code 10th Revision algorithms for accurate identification of pulmonary embolism

Behnood Bikdeli et al. J Thromb Haemost. 2025 Feb.

Abstract

Background: Many research investigations for pulmonary embolism (PE) rely on the International Classification of Diseases 10th Revision (ICD-10) codes for analyses of electronic databases. The validity of ICD-10 codes in identifying PE remains uncertain.

Objectives: The objective of this study was to validate an algorithm to efficiently identify pulmonary embolism using ICD-10 codes.

Methods: Using a prespecified protocol, patients in the Mass General-Brigham hospitals (2016-2021) with ICD-10 principal discharge codes for PE, those with secondary codes for PE, and those without PE codes were identified (n = 578 from each group). Weighting was applied to represent each group proportionate to their true prevalence. The accuracy of ICD-10 codes for identifying PE was compared with adjudication by independent physicians. The F1 score, which incorporates sensitivity and positive predictive value (PPV), was assessed. Subset validation was performed at Yale-New Haven Health System.

Results: A total of 1712 patients were included (age: 60.6 years; 52.3% female). ICD-10 PE codes in the principal discharge position had sensitivity and PPV of 58.3% and 92.1%, respectively. Adding secondary discharge codes to the principal discharge codes improved the sensitivity to 83.2%, but the PPV was reduced to 79.1%. Using a combination of ICD-10 PE principal discharge codes or secondary codes plus imaging codes for PE led to sensitivity and PPV of 81.6% and 84.7%, respectively, and the highest F1 score (83.1%; P < .001 compared with other methods). Validation yielded largely similar results.

Conclusion: Although the principal discharge codes for PE show excellent PPV, they miss 40% of acute PEs. A combination of principal discharge codes and secondary codes plus PE imaging codes led to improved sensitivity without severe reduction in PPV.

Keywords: International Classification of Diseases; accuracy; administrative claims; electronic health records; pulmonary embolism.

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Conflict of interest statement

Declaration of competing interests Outside the submitted work, B.B. was supported by the Scott Schoen and Nancy Adams IGNITE Award and is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital and the Heart and Vascular Center Junior Faculty Award from Brigham and Women’s Hospital. B.B. reports that he was a consulting expert on behalf of the plaintiff for litigation related to 2 specific brand models of inferior vena cava filters. B.B. has not been involved in the litigation from 2022 to 2024, nor has he received any compensation from 2022 to 2024. B.B. reports that he is a member of the Medical Advisory Board for the North American Thrombosis Forum and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute and Translational Sciences. B.B. is a collaborating consultant with the International Consulting Associates and the US Food and Drug Administration in a study to generate knowledge about the utilization, predictors, retrieval, and safety of inferior vena cava filters. B.B. receives compensation as an Associated Editor for the New England Journal of Medicine Journal Watch Cardiology, as an Associate Editor for Thrombosis Research, and as an Executive Associate Editor for JACC, and is a Section Editor for Thrombosis and Haemostasis (no compensation). E.A.S. receives funding from NIH/National Heart, Lung, and Blood Institute K23HL150290, Food & Drug Administration, and SCAI. G.P. received research grants from Abbott/CSI, BD, Boston Scientific, Cook, Medtronic, and Philips. E.A.S. reports to the consulting/speakers board for Abbott/CSI, BD, BMS, Boston Scientific, Cagent, Conavi, Cook, Cordis, Endovascular Engineering, Gore, InfraRedx, Medtronic, Philips, RapidAI, Rampart, Shockwave, Siemens, Terumo, Thrombolex, VentureMed, and Zoll. G.P. received research grants from BMS/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and 1R01HL164717-01. G.P. reports an advisory role for BSC, Amgen, BCRI, PERC, NAMSA, BMS, Janssen, and Regeneron. A.B. would like to acknowledge the training received under the Scholars in HeAlth Research Program (SHARP) that was in part supported by the Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health (Award Number D43 TW009118). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The other authors have no conflicts of interest to disclose.

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