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Fowler XP, Eid MA, Barnes JA, Mehta KS, Bratches RW, Hu D, Goodney E, Creager MA, Bonaca MP, Feinberg MW, Moore KO, Gladders B, Armstrong DG, Goodney PP. Deriving International Classification of Diseases, 9th and 10th revision, codes for identifying and following up patients with diabetic lower extremity ulcers. J Vasc Surg Cases Innov Tech 2022; 8:877-884. [PMID: 36568954 PMCID: PMC9768238 DOI: 10.1016/j.jvscit.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Administrative claims data offer a rich data source for clinical research. However, its application to the study of diabetic lower extremity ulceration is lacking. Our objective was to create a widely applicable framework by which investigators might derive and refine the International Classification of Diseases, 9th and 10th revision (ICD-9 and ICD-10, respectively) codes for use in identifying diabetic, lower extremity ulceration. Methods We created a seven-step process to derive and refine the ICD-9 and ICD-10 coding lists to identify diabetic lower extremity ulcers. This process begins by defining the research question and the initial identification of a list of ICD-9 and ICD-10 codes to define the exposures or outcomes of interest. These codes are then applied to claims data, and the rates of clinical events are examined for consistency with prior research and changes across the ICD-9 to ICD-10 transition. The ICD-9 and ICD-10 codes are then cross referenced with each other to further refine the lists. Results Using this method, we started with 8 ICD-9 and 43 ICD-10 codes used to identify lower extremity ulcers in patients with known diabetes and peripheral arterial disease and examined the association of ulceration with lower extremity amputation. After refinement, we had 45 ICD-9 codes and 304 ICD-10 codes. We then grouped the codes into eight clinical exposure groups and examined the rates of amputation as a rudimentary test of validity. We found that the rate of lower extremity amputation correlated with the severity of lower extremity ulceration. Conclusions We identified 45 ICD-9 and 304 ICD-10 ulcer codes, which identified patients at risk of amputation from diabetes and peripheral artery disease. Although further validation at the medical record level is required, these codes can be used for claims-based risk stratification for long-term outcomes assessment in the treatment of patients at risk of limb loss.
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Affiliation(s)
- Xavier P Fowler
- Department of General Surgery, Veterans Affairs Medical Center, White River Junction, VT
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark A Eid
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Aaron Barnes
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kunal S Mehta
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - David Hu
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Ella Goodney
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Kayla O Moore
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara Gladders
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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