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Master of Public Health

Pneumonia Hospitalization Coding Changes Associated With Transition From the 9th to 10th Revision of

AUTHORS

Smithee RB , Markus TM , Soda E , Grijalva CG , Xing W , Shang N , Griffin MR , Lessa FC , . Health services research and managerial epidemiology. 2020 7 24; 7(). 2333392820939801

ABSTRACT

Objectives: To evaluate the impact of , 10th revision, Clinical Modification () implementation on pneumonia hospitalizations rates, which had declined following pneumococcal conjugate vaccine introduction for infants in 2000.

Methods: We randomly selected records from a single hospital 1 year before (n = 500) and after (n = 500) October 2015 implementation of coding. We used a validated algorithm and translation of that algorithm to to identify pneumonia hospitalizations pre- and post-implementation, respectively. We recoded records to and vice versa. We calculated sensitivity and positive predictive value (PPV) of the algorithm using coding as the reference. We used sensitivity and PPV values to calculate an adjustment factor to apply to era rates to enable comparison with rates. We reviewed primary diagnoses of charts not meeting the pneumonia definition when recoded.

Results: Sensitivity and PPV of the algorithm were 94% and 92%, respectively, for young children and 74% and 79% for older adults. The estimated adjustment factor for period rates was -2.09% (95% credible region [CR], -7.71% to +3.0%) for children and +6.76% (95% CR, -3.06% to +16.7%) for older adults. We identified a change in coding adult charts that met the pneumonia definition that led to recoding in as chronic obstructive pulmonary disease (COPD) exacerbation.

Conclusions: The algorithm derived from a validated algorithm should not introduce substantial bias for evaluating pneumonia trends in children. However, changes in coding of pneumonia associated with COPD in adults warrant further study.

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