Validation of ICD-10-CM surveillance codes for traumatic brain injury inpatient hospitalizations

ABSTRACT

Objective: Using inpatient data from a 1,160-bed health system, we assessed the positive predictive value (PPV) of ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes included in a traumatic brain injury (TBI) surveillance definition proposed by the Centers for Disease Control and Prevention (CDC) in 2016.

Methods: A random sample of 196 records with ICD-10-CM TBI codes was reviewed. The PPVs for the ICD-10-CM codes’ ability to capture true TBI cases were calculated as the percentage of records with confirmed clinical provider-documented TBI and reported with 95% confidence intervals [95%CIs].

Results: The estimated overall PPV was 74% [67.9%, 80.1%] when the codes were listed in any diagnostic field, but 91.5% [86.2%, 96.8%] when listed as the principal diagnosis. S06 codes (intracranial injury) had an overall PPV of 80.2% [74.3%, 86.1%] and 96.9% [93.3%, 100%] when listed as the principal diagnosis. S02.0-.1 codes (vault/base skull fractures) in any position without co-existing S06 codes had a PPV of 15.8% [0%, 33.2%].

Conclusions: Intracranial injury codes (S06) in any diagnostic position had a very high estimated PPV. Further research is needed to determine the utility of other codes included in the CDC proposed definition for TBI surveillance.

KEYWORDS:

• Surveillance definition
• traumatic brain injury
• positive predictive value
• ICD-10-CM
• medical record review

Acknowledgments

The authors gratefully acknowledge Andrew Bernard, MD, MS for his clinical expertise and assistance in answering clinical questions involved in this review. The authors acknowledge support from the Office of Health Data and Analytics, Kentucky Cabinet for Health and Family Services, for providing administrative billing data for this study.

Disclosure of Interest

The authors report no conflicts of interests. The research described was supported in part by the NIH National Center for Advancing Translational Science, through training grant number TL1TR001997. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This work was also supported by a Grant (U17 CE924846) funded by the Centers for Disease Control and Prevention and awarded to the Kentucky Injury Prevention and Research Center as bona fide agent for the Kentucky Department for Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, or the Department of Health and Human Services.

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention [U17 CE924846]; National Center for Advancing Translational Sciences [TL1TR001997].