Adaptation and Validation of the Combined Comorbidity Score for ICD-10-CM. Issue 12 (December 2017)

• Record Type: Journal Article
• Authors: Sun, Jenny W.; Rogers, James R.; Her, Qoua; Welch, Emily C.; Panozzo, Catherine A.; Toh, Sengwee; Gagne, Joshua J.
• Is Part Of: Medical care. Volume 55:Issue 12(2017)
• Publication Date: 2017-12
• Subjects: ICD-10 -- ICD-9 -- comorbidity -- claims data; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000824
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: The combined comorbidity score, which merges the Charlson and Elixhauser comorbidity indices, uses the ninth revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM). In October 2015, the United States adopted the 10th revision (ICD-10-CM). Objective: The objective of this study is to examine different coding algorithms for the ICD-10-CM combined comorbidity score and compare their performance to the original ICD-9-CM score. Methods: Four ICD-10-CM coding algorithms were defined: 2 using General Equivalence Mappings (GEMs), one based on ICD-10-CA (Canadian modification) codes for Charlson and Elixhauser measures, and one including codes from all 3 algorithms. We used claims data from the Clinfomatics Data Mart to identify 2 cohorts. The ICD-10-CM cohort comprised patients who had a hospitalization between January 1, 2016 and March 1, 2016. The ICD-9-CM cohort comprised patients who had a hospitalization between January 1, 2015 and March 1, 2015. We used logistic regression models to predict 30-day hospital readmission for the original score in the ICD-9-CM cohort and for each ICD-10-CM algorithm in the ICD-10-CM cohort. Results: Distributions of each version of the score were similar. The algorithm based on ICD-10-CA codes [ c -statistic, 0.646; 95% confidence interval (CI), 0.640–0.653] had the most similar discrimination for readmission to the ICD-9-CM version (c, 0.646; 95% CI, 0.639–0.653), but combining all identified ICD-10-CM codes had the highest c -statistic (c, 0.651; 95% CI, 0.644–0.657). Conclusions: We propose an ICD-10-CM version of the combined comorbidity score that includes codes identified by ICD-10-CA and GEMs. Compared with the original score, it has similar performance in predicting readmission in a population of United States commercially insured individuals. Abstract : Supplemental Digital Content is available in the text.