Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study

ICD-10-CM diagnosis code classification scheme

Following the approach used in previous studies,67151617 we classified each of the 91 738 diagnosis codes in the 2016 version of ICD-10-CM as “always” if the associated condition is almost always an indication for antibiotics (eg, pneumonia or urinary tract infection), “sometimes” if the condition is a potential indication for antibiotics (eg, acute sinusitis or acute otitis media), and “never” if the condition is almost never an indication for antibiotics (eg, acute upper respiratory tract infection, acute bronchitis, or non-infectious conditions). We did not adapt previous ICD-9-CM based classification schemes to ICD-10-CM owing to the differences between these coding systems. Additionally, we aimed to develop a scheme that could be applied to any administrative dataset. Therefore, we created a new scheme in which we classified each ICD-10-CM diagnosis code one by one. The primary author (KC) initially decided on the classifications, which the other authors (JAL and MAF) reviewed; disagreements were resolved by discussion until consensus was achieved. The authors included one general pediatrician and two general internists with expertise in the measurement of antibiotic overuse and medication use in administrative data.361819

In developing the scheme, we erred on the side of assuming appropriate antibiotic use. For example, we classified several codes as “always” even though antibiotics might not always be required (eg, pneumonia is often viral). As another example, we classified several diagnosis codes as “sometimes” even when oral antibiotics are rarely necessary (eg, infective otitis externa), or even when the diagnosis code typically implies a viral illness (eg, infectious colitis and gastroenteritis). As a final example, we classified some non-specific diagnosis codes as “sometimes” when they might be used to denote complications requiring antibiotics (eg, superficial thrombophlebitis, a diagnosis code that could be used for thrombophlebitis complicated by cellulitis).

Bạn đang xem: Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study

Xem thêm : Blog

Appendix 2 includes additional details about the classification scheme. For illustrative purposes, box 1 presents the classification scheme for diseases of the respiratory system (ICD-10-CM codes J00-J99), which are among the most common indications for outpatient antibiotic prescriptions.6 Appendix 3 includes a table summarizing the scheme by diagnosis code category. We also developed a similar classification scheme (although not used in the current study) of all 17 553 diagnosis codes in the final 2015 version of ICD-9-CM to facilitate analyses using older datasets, as well as a classification scheme of all 94 249 codes in the 2017 version of ICD-10-CM. Appendix 4 discusses the comparability of the 2015 ICD-9-CM and 2016 ICD-10-CM scheme. For each version of the scheme, a full list of classification decisions is included online.

Nguồn: https://vuihoctienghan.edu.vn
Danh mục: Info