Abstract 17709: ICD-10 Codes Have Low Sensitivity and Suboptimal Positive Predictive Value for Identifying Cases of Pulmonary Embolism With Cor Pulmonale in Electronic Healthcare Records
Circulation, vol. 148
Abstract
Introduction: The International Classification of Diseases, 10 th revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with cor pulmonale . These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown. Methods: We reviewed patient data from Mass General Brigham (MGB) health system (01/2016-12/2021). Patients were randomly selected from 3 groups: Patients with Principal discharge diagnosis codes for PE, patients with secondary discharge diagnosis of PE, and patients with no PE codes. Accuracy of codes for PE with cor pulmonale were assessed with reference to manual review by 2 independent physicians using pre-specified criteria. Weighted estimates were obtained by considering the total number of hospitalizations. Results: 1,712 patients were included (age: 60.6±17.8 years, 52.3% female). Chart review found 865 patients with PE, of whom 360 (41.6%) had PE with cor pulmonale according to predefined clinical criteria. Of these 360 PE patients, 358 (99.4%) had ICD-10 codes for PE. However, only in 36 (10.1%) cases, the specific cor pulmonale codes were used. There were 24 additional cases with ICD-10 codes for PE with cor pulmonale in whom the diagnosis was not confirmed per manual review. Sensitivity and specificity for PE with cor pulmonale codes in Principal-or-secondary position were 10.0% and 98.2% (Table, panel A). The positive predictive value (PPV) for PE with cor pulmonale in Principal-or-secondary discharge position was 63.2% in the weighted sample (Table, panel B). Conclusions: ICD-10 codes for identification of acute PE with cor pulmonale have excellent specificity, but very poor sensitivity and suboptimal PPV. These results are informative for investigators who may use such ICD-10 codes for research or quality improvement purposes.
Authors 25
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Antoine Bejjani Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Brigham and Womens Hosp, Boston, MA
Candrika D Khairani Brigham and Womens Hosp, Boston, MA
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Affiliation as printed
Brigham and Women's Hosp, Brookline, MA
Ying-Chih Lo Brigham and Women's Hosp, Brookline, MA
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Hospital Universitario Ramón y Cajal
Affiliation as printed
Ramon and Cajal Univ Hosp, Madrid
David Jimenez Ramon and Cajal Univ Hosp, Madrid
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University of Zurich · University Hospital Zurich
Affiliation as printed
Univ Hosp Zurich, Zurich
Stefano Barco Univ Hosp Zurich, Zurich
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Affiliation as printed
Yale Sch of Medicine, New Haven, CT
Shiwani Mahajan Yale Sch of Medicine, New Haven, CT
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Affiliation as printed
Yale Sch of Medicine, New Haven, CT
Cesar Caraballo Yale Sch of Medicine, New Haven, CT
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Beth Israel Deaconess Medical Center · Beth Israel Deaconess Hospital
Affiliation as printed
BIDMC, Boston, MA
Eric A Secemsky BIDMC, Boston, MA
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Affiliation as printed
Leiden Univ, Leiden
Erik Klok Leiden Univ, Leiden
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Andetta Hunsaker Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Ayaz Aghayev Brigham and Women's Hosp, Boston, MA
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Hospital Universitario Ramón y Cajal
Affiliation as printed
Ramon and Cajal Univ Hosp, Madrid
Alfonso Muriel Ramon and Cajal Univ Hosp, Madrid
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Mohamad A Hussain Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Abena Appah-Sampong Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Yale Univ Sch of Medicine, New Haven, NY
HAMID MOJIBIAN Yale Univ Sch of Medicine, New Haven, NY
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Affiliation as printed
Yuan Lu, Jersey City, NJ
Yuan Lu Yuan Lu, Jersey City, NJ
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Affiliation as printed
Yale Univ, Cheshire, CT
Zhenqiu Lin Yale Univ, Cheshire, CT
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Affiliation as printed
Yale Sch Of Medicine, New Haven, MI
Sanjay Aneja Yale Sch Of Medicine, New Haven, MI
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Affiliation as printed
Yale Sch of Medicine, New Haven, CT
Rohan Khera Yale Sch of Medicine, New Haven, CT
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Samuel Goldhaber Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Brigham and Women's Hosp
Li Zhou Brigham and Women's Hosp
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Hospital Universitari Germans Trias i Pujol
Affiliation as printed
Hosp Universitari Germans Trias i Pujol
Manuel Monreal Hosp Universitari Germans Trias i Pujol
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Affiliation as printed
Brigham and Women's Hosp, Boston, MA
Gregory Piazza Brigham and Women's Hosp, Boston, MA
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Affiliation as printed
Yale Univ, New Haven, CT
Harlan M Krumholz Yale Univ, New Haven, CT
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Affiliation as printed
Brigham and Womens Hosp, Boston, MA
Behnood Bikdeli Brigham and Womens Hosp, Boston, MA
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