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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. ICD-9 to ICD-10 Comparability: Applicability to Injury Data. Lois A. Fingerhut, MA and Margaret Warner, PhD

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

ICD-9 to ICD-10 Comparability:

Applicability to Injury Data

Lois A. Fingerhut, MA and Margaret Warner, PhD

Special Projects Branch, Office of Analysis and Epidemiology


Overview
Overview

  • Process of developing ICD-10 codes for external cause matrix

  • Comparability ratio

  • Percent agreement

  • Application of comparability ratio

  • Comparability for multiple cause diagnosis data


Development of comparability based on external cause ec of injury matrix
Development of Comparability based on External Cause (EC) of Injury Matrix

  • Development of ICD-10 EC matrix

    • Compare ICD-9 to ICD-10 code by code for underlying cause of death

    • Some movement of codes in ICD-9 matrix based on changes to ICD-10 (e.g. MVT) and updates (e.g. drowning)

    • Validate with comparability ratios

  • For trends, ICD-9 EC matrix adjusted to match ICD-10 EC matrix


Final comparability ratios by intent
Final Comparability Ratios by Intent Injury Matrix

  • All injury 1.0159

  • Unintentional 1.0251

  • Suicide 1.0022

  • Homicide 1.0020

  • Undetermined 0.9867

  • Legal interv/war 0.9235


Effect of final comparability ratios by intent on 1998 death rates
Effect of Final Comparability Ratios by Intent on 1998 death rates

CR CDR CMR

  • All injury 1.0159 * 53.3=54.1

  • Unintentional 1.0251 *34.2= 35.1

  • Suicide 1.0022 * 11.1=11.1

  • Homicide 1.0020 * 6.5= 6.5

  • Undetermined 0.9867 * 1.4= 1.3

  • Legal interv/war 0.9235 * 0.1= 0.1

CR- comparability ratio, CDR- crude death rate, CMR- comparability modified rate


Effect of final comparability ratios by mechanism on 1998 death rates
Effect of Final Comparability Ratios by Mechanism on 1998 death rates

CR CDR CMR

  • MVT .9545 * 15.3=14.6

  • Firearm 1.0012 *11.1=11.1

  • Poisoning 1.0192 * 6.7=6.8

  • Fall 1.0015 * 4.8= 4.8

  • Suffocation 1.0974 *4.0= 4.4



Transportation related injuries
Transportation-related injuries “worst” ratios

  • Not 1-to-1 match for many codes

  • Often no comparable ICD-10 codes

    • Almost 20% of all ICD-9 MVT deaths

  • Comparability ratios

    • All transport 0 .9930

    • Other land transport 2.6350

    • Pedal cyclist, MVT 0.8038

    • Pedal cyclist, other 1.7477


Other summary measures
Other summary measures “worst” ratios

  • Comparability ratio summarizes net effect

  • Percent agreement between ICD-9 and ICD-10

    • Inflows – in ICD-10 but not ICD-9

    • Outflows – in ICD-9 but not ICD-10

    • Coded to both


Example suffocation
Example: Suffocation “worst” ratios

  • Total ICD-9 = 9,888

  • Total ICD-10 = 10,851

  • CR = 1.0974 (10 % more in 10 than in 9)

    • Agreement 9,716 88 %

    • Outflows (ICD-9 & not ICD-10) 172 2 %

    • Inflows (ICD-10 & not ICD-9)1,135 10 %


Example suffocation1
Example: Suffocation “worst” ratios

  • Inflows to suffocation (n=1,135)

  • From Natural Causes 780 69%

    Pneumonia 208 18% Residual disease 189 17% Pneumonitis 124 11%

  • From External Causes 355 31%


Multiple cause of death comparability issues for injury diagnoses
Multiple cause of death comparability issues for injury diagnoses

  • No precedent exists, no standard cause of death lists for injury diagnoses

  • Entity vs Record axis codes

  • All mentions vs any mention of an injury

  • ICD-9 and ICD-10 have opposite axes for injury diagnoses

    • ICD-9 by nature of injury (fractures, open wounds..)

    • ICD-10 by body region of injury


Multiple cause of death comparability issues for injury diagnoses1
Multiple cause of death comparability issues for injury diagnoses

  • Need a standard format to compare ICD-9 and ICD-10 diagnosis or nature of injury codes

  • A revised Barell Matrix is needed

    • Current version uses ICD-9 CM injury diagnosis codes

    • ICD-9 CM codes have 4th and 5th digits

    • Most mortality codes have only 3 digits

  • Comparability issues are abundant…


Amputations
Amputations…. diagnoses

  • ICD-9 codes applied only to upper and lower limbs

  • ICD-10 codes are far more extensive also covering thorax, head, neck, trunk, multiple body regions

    CR % agreement

    All Amputations 2.26 27%

    Matching ‘limb’ codes 0.85 58%


Conclusions
Conclusions diagnoses

  • Important to consider comparability

  • Large differences in transportation codes

  • Trends: Basic recommendations

    • If at all possible, do not combine across revisions

    • Apply CR to 1998 data only

  • On web in near future-- Death and death rates for ICD-9 comparability modified EC matrix by age and sex

  • How to deal with nature of injury codes—work in progress


Questions comments lois fingerhut lfingerhut@cdc gov or margaret warner mwarner@cdc gov
Questions/Comments diagnosesLois [email protected] [email protected]


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