Validity of ICD-10-CM Codes Used to Identify Patients with Chronic Hepatitis B and C Virus Infection in Administrative Claims Data from the Taiwan National Health Insurance Outpatient Claims Dataset

Figures & data

Figure 1 Flow of data linkage and exclusion.

Table 1 Characteristics of Subjects with Hepatitis B Virus Surface Antigen/Hepatitis B Virus e Antigen or Anti-Hepatitis C Virus Tests in Taiwan NHI Lab & Exam Dataset from January 1 to March 31, 2018, and in Taiwanese Population as a Whole

	HBsAg/HBeAg		Anti-HCV		Taiwan
	No.	(%)	No.	(%)	No.	(%)
All patients	196,635	(100)	120,628	(100)	23,588,932	(100)
Sex
Men	104,666	(53)	62,836	(52)	11,712,913	(50)
Women	91,968	(47)	57,791	(48)	11,876,019	(50)
Age
≤44 years	50,994	(26)	30,274	(25)	13,097,880	(56)
45–64 years	95,386	(49)	54,440	(45)	7,057,535	(30)
≥65 years	48,755	(25)	35,914	(30)	3,433,517	(15)
Region
Taipei	63,797	(32)	39,768	(33)	7,641,994	(32)
North	31,632	(16)	17,685	(15)	3,772,380	(16)
Central	31,678	(16)	18,784	(16)	4,578,749	(19)
South	31,904	(16)	20,646	(17)	3,345,543	(14)
Kauping	32,377	(16)	19,994	(17)	3,703,379	(16)
East	5,065	(3)	3,642	(3)	546,887	(2)

Abbreviations: HBsAg, hepatitis B virus surface antigen; HBeAg, hepatitis B virus e antigen; Anti-HCV, hepatitis C virus antibody.

Table 2 Performance of Using International Classification of Diseases, Tenth Revision, Clinical Modification, Codes in Identifying Patients with Chronic Hepatitis B (A) or C (B) Virus in Taiwan National Health Insurance Outpatient Claims Data, 2018

A
ICD-10-CM Codes	Confirmed HBV Case	Not a HBV Case	Total
B180, B181, B191	20,621	25,644	46,265
No B180, B181, B191	23,953	126,417	150,370
Total	44,574	152,061	196,635
Sensitivity, 20,621/44,474 (46.3%) Specificity, 126,417/152,061 (83.1%) Positive predictive value, 20,621/46,265 (44.6%) Negative predictive value, 126,417/150,370 (84.1%)
B
ICD-10-CM Codes	Confirmed HCV Case	Not a HCV Case	Total
B182, B192	6,767	1,612	8,379
No B182, B192	7,676	104,573	112,249
Total	14,443	106,185	120,628
Sensitivity, 6,767/14,443 (46.9%) Specificity, 104,573/112,249 (98.5%) Positive predictive value, 6,767/8,379 (80.8%) Negative predictive value, 104,573/112,249 (93.2%)

Abbreviations: HBV, chronic hepatitis B virus; HCV, chronic hepatitis C virus; ICD-10-CM, International Classification of Diseases Tenth Revision, Clinical Modification.

Table 3 Performance of Using International Classification of Diseases, Tenth Revision, Clinical Modification, Codes (B180, B181, B191) to Identify Patients with Chronic Hepatitis B Virus in Taiwan National Health Insurance Outpatient Claims Data, by Characteristics, 2018

	Sen	(95% CI)	Spe	(95% CI)	PPV	(95% CI)	NPV	(95% CI)
All patients	46.3	(45.8−46.7)	83.1	(82.9−83.3)	44.6	(44.1−45.0)	84.1	(83.9−84.3)
Sex
Men	49.9	(49.3−50.5)	79.5	(79.2−79.8)	43.9	(43.4−44.4)	83.1	(82.9−83.4)
Women	41.5	(40.8−42.2)	87.1	(86.9−87.3)	45.7	(45.0−46.5)	85.0	(84.8−85.3)
Age
≤44 years	48.0	(47.1−48.9)	85.3	(85.0−85.7)	51.4	(50.5−52.3)	83.5	(83.2−83.9)
45–64 years	46.5	(45.9−47.1)	79.0	(78.7−79.3)	42.6	(42.0−43.2)	81.5	(81.2−81.8)
≥65 years	42.9	(41.8−44.0)	86.8	(86.5−87.2)	39.6	(38.6−40.6)	88.3	(88.0−88.6)
Region
Taipei	47.5	(46.7−48.3)	83.2	(82.9−83.5)	46.0	(45.2−46.8)	84.0	(83.7−84.4)
North	29.6	(28.6−30.6)	90.9	(90.6−91.3)	54.2	(52.8−55.6)	78.1	(77.6−78.6)
Central	59.4	(58.2−60.5)	79.8	(79.3−80.3)	45.2	(44.2−46.2)	87.5	(87.1−87.9)
South	54.6	(53.3−56.0)	79.0	(78.5−79.5)	34.3	(33.3−35.3)	89.7	(89.3−90.0)
Kauping	46.8	(45.7−47.9)	83.2	(82.7−83.6)	46.8	(45.7−47.9)	83.2	(82.7−83.6)
East	32.0	(29.4−34.5)	85.1	(84.0−86.2)	42.2	(39.1−45.3)	78.6	(77.4−79.9)
Clinical setting
Medical centers	46.8	(46.0−47.5)	82.1	(81.8−82.5)	51.1	(50.4−51.9)	79.4	(79.0−79.8)
Regional hospitals	53.8	(53.0−54.7)	79.8	(79.4−80.1)	39.1	(38.4−39.8)	87.8	(87.5−88.0)
District hospitals	47.6	(46.5−48.8)	85.0	(84.5−85.4)	44.7	(43.6−45.8)	86.4	(86.0−86.8)
Clinics	16.6	(15.4−17.7)	94.0	(93.7−94.4)	39.9	(37.6−42.2)	82.4	(81.9−82.9)
Physician specialty
GI & Hepa	65.8	(65.2−66.4)	57.3	(56.9−57.8)	45.4	(44.9−45.9)	75.7	(75.2−76.1)
Others	21.1	(20.5−21.7)	94.5	(94.4−94.6)	41.5	(40.5−42.4)	86.6	(86.4−86.8)

Abbreviations: GI & Hepa, gastroenterology and hepatology; Sen, sensitivity; Spe, specificity; PPV, positive predictive value; NPV, negative predictive value.

Table 4 Performance of Using International Classification of Diseases, Tenth Revision, Clinical Modification, Codes (B182, B192) to Identify Patients with Chronic Hepatitis C Virus in Taiwan National Health Insurance Outpatient Claims Data, by Characteristics, 2018

	Sen	(95% CI)	Spe	(95% CI)	PPV	(95% CI)	NPV	(95% CI)
All patients	46.9	(46.0−47.7)	98.5	(98.4−98.6)	80.8	(79.9−81.6)	93.2	(93.0−93.3)
Sex
Men	47.8	(46.6−48.9)	98.6	(98.5−98.7)	80.9	(79.7−82.0)	93.6	(93.4−93.8)
Women	46.0	(44.8−47.1)	98.4	(98.3−98.5)	80.7	(79.5−81.9)	92.6	(92.4−92.9)
Age
≤44 years	47.2	(44.8−49.6)	99.2	(99.1−99.3)	78.6	(76.0−81.1)	97.0	(96.8−97.2)
45–64 years	47.9	(46.7−49.1)	98.4	(98.3−98.5)	80.2	(78.9−81.4)	93.3	(93.1−93.5)
≥65 years	45.7	(44.4−46.9)	97.9	(97.7−98.0)	82.0	(80.7−83.3)	89.5	(89.2−89.8)
Region
Taipei	48.4	(46.7−50.1)	98.4	(98.3−98.6)	73.9	(72.0−75.7)	95.5	(95.3−95.7)
North	36.1	(34.0−38.3)	99.3	(99.2−99.4)	86.2	(83.8−88.5)	92.8	(92.4−93.1)
Central	46.8	(44.5−49.1)	98.8	(98.7−99.0)	80.7	(78.3−83.1)	94.6	(94.3−94.9)
South	54.3	(52.9−55.7)	98.6	(98.4−98.8)	92.1	(91.1−93.1)	87.8	(87.3−88.3)
Kauping	40.3	(38.3−42.3)	97.6	(97.4−97.8)	68.9	(66.5−71.4)	92.6	(92.2−92.9)
East	32.4	(27.4−37.4)	97.3	(96.7−97.8)	54.8	(47.9−61.7)	93.4	(92.6−94.2)
Clinical setting
Medical centers	48.2	(46.6−49.7)	98.8	(98.7−99.0)	83.2	(81.7−84.7)	94.2	(93.9−94.4)
Regional hospitals	52.0	(50.8−53.2)	97.8	(97.6−97.9)	79.9	(78.7−81.1)	92.3	(92.0−92.6)
District hospitals	43.3	(41.5−45.1)	98.9	(98.7−99.0)	85.4	(83.6−87.3)	92.1	(91.7−92.5)
Clinics	13.2	(11.0−15.5)	99.0	(98.8−99.2)	46.0	(39.8−52.2)	94.7	(94.3−95.1)
Physician specialty
GI & Hepa	75.2	(74.2−76.2)	94.1	(93.8−94.4)	81.7	(80.8−82.7)	91.6	(91.2−91.9)
Others	21.9	(20.9−22.8)	99.5	(99.4−99.5)	78.0	(76.2−79.7)	93.5	(93.3−93.7)

Abbreviations: GI & Hepa, gastroenterology and hepatology; Sen, sensitivity; Spe, specificity; PPV, positive predictive value; NPV, negative predictive value.