Agreement between medical record and administrative coding of common comorbidities in orthopaedic trauma patients. Issue 7 (July 2019)

• Record Type: Journal Article
• Authors: Daly, Stuart; Nguyen, Tu Q.; Gabbe, Belinda J.; Braaf, Sandra; Simpson, Pamela; Ekegren, Christina L.
• Is Part Of: Injury. Volume 50:Issue 7(2019)
• Page Start: 1277
• Page End: 1283
• Publication Date: 2019-07
• Subjects: Comorbidity -- ICD-10-AM -- Orthopaedic -- Trauma -- Agreement; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.05.004
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Comorbidities were under-reported in ICD-10-AM coded data compared to medical records at an Australian major trauma centre. Caution must be taken with ICD-10-AM-coded comorbidity data in studies, registries and health care policy development. In 2015, new comorbidity coding rules were introduced to Australian hospitals with introduction of supplementary 'U codes'. Supplementary 'U codes' for conditions increased the agreement between medical records and ICD-10-AM hospital coded data. Abstract: Objective: To i) quantify the agreement between comorbidities documented within medical records and an orthopaedic trauma dataset; and ii) compare agreement between these sources before and after the introduction of new comorbidity coding rules in Australian hospitals. Study design and setting: A random sample of adult (≥ 16 years) orthopaedic trauma patients (n = 400) were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Diagnoses of obesity, arthritis, diabetes and cardiac conditions documented within patients' medical records were compared to ICD-10-AM comorbidity codes (provided by hospitals) for the same admission. Agreement was calculated (Cohen's kappa) before and after the introduction of new coding rules. Results: All comorbidities had the same or higher prevalence in medical record data compared to coded data. Kappa values ranged from <0.001 (poor agreement) for coronary artery disease to 0.94 (excellent agreement) for type 2 diabetes. There was improvement in agreement between sources for most conditions following the introduction of new coding rules. Conclusion: There has been improvement in the coding of certain comorbidities since the introduction of new coding rules, suggesting that, since 2015, administrative data has improved capacity to capture patients' comorbidity profiles. Consideration must be taken when using the ICD-10-AM data due to its limitations.