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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
  • 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
  • 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
  • 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
  • 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
  • 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….
  • 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
  • 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
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