A Multi-hospital, Single Center Validation of ICD-10-CM Coding for Status Epilepticus
Abstract number :
1.13
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
991
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Megan MacKenzie, MD – Mount Sinai West
Nathalie Jette, MD, MSc – Cumming School of Medicine at the University of Calgary
Parul Agarwal, PhD, MPH – Icahn School of Medicine at Mount Sinai
Cristina Schreckinger-Rodas, MD – St. Mary's Neurological Specialists
Carolina Ferreira-Atuesta, MD, MSc – Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
Samantha Townes, AS – Mount Sinai
Brian Mathew, BS – Rowan University School of Osteopathic Medicine
Ariella Cohen, MD – Children's Hospital of Philadelphia
Sharon Nirenberg, MD, MS – Mount Sinai
Leah Blank, MD – Icahn School of Medicine at Mount Sinai
Rationale: Status epilepticus (SE) is a common, life-threatening neurologic emergency and frequent neurologic cause of admission to the Intensive Care Unit. Understanding population level outcomes after SE requires a validated case definition, yet International Classification of Diseases 10th revision clinical modification (ICD-10-CM) codes of SE have not been well-validated in US populations since their adoption in 2015. We therefore aimed to determine whether the ICD-10-CM code-based definitions accurately identify SE in the in-hospital setting.
Methods: Study population included patients of all ages (excluding neonates) admitted to a Mount Sinai Health System (MSHS) ICU in 2019. A data collection form was developed, tested and used by trained reviewers. Every admission in a randomly selected month (November) was reviewed to determine if all SE cases had at least one code for epilepsy, seizure or convulsion. We then reviewed all charts with an ICD-10-CM diagnosis code for seizure/epilepsy/convulsion in 2019. Chart review data were linked to MSHS EMR data. We calculated sensitivity (Sn) specificity (Sp), negative (NPV) and positive predictive value (PPV) with 95% confidence intervals and Youden’s Index of ICD-10 coding for status epilepticus (G40.xx1 or G40.xx3, as G41 was not adopted in the US).
Results: In 2019 within MSHS there were 13,694 ICU admissions, of which 1851 charts were reviewed. We identified 173 admissions with definite SE. The ICD-10-CM case definition has a Sn of 45.7% (95% Confidence Interval (CI) 39.4-52.1%) and Sp of 97.3% (95% CI 96.5-98.1%) in our cohort. PPV was 71.5% (95% CI 64.3-78.7%), and the NPV was 92.4% (95% CI 91.2-93.7%), Youden’s Index was 43.1%.
Conclusions: Our results show that ICD-10-CM coding for status epilepticus has high specificity but limited sensitivity. These findings align with SE prevalence studies showing a decrease in prevalence with the coding change from ICD-9-CM to ICD-10-CM, which may be related to the unique adoption of ICD-10-CM coding for status in the US which did not include the stand-alone SE code (G41). Due to this difference in adoption, patients with acute SE and without epilepsy may not be captured under US ICD-10-CM coding. In conclusion, our findings emphasize the importance for continuous revision and improvement of coding practices to better represent the prevalence of SE, and important considerations when planning for the next iteration of ICD coding.
Funding: This study was supported by the NORSE Foundation through an American Epilepsy Society Seed Grant.
Health Services (Delivery of Care, Access to Care, Health Care Models)