Background
Methods
APPROACH Project
Clinical variables
Administrative data source
APPROACH Methods
Derivation of the ICD-10 algorithm
Implementation of ICD-10 merge
Analysis
Variables | ICD-9-CM code | ICD-10 code |
---|---|---|
Cerebrovascular disease
| 430.x–438.x | G45.x, G46.x, H34.0, I60.x–I69.x |
Pulmonary (COPD)
| 490.x–496.x, 500.x–505.x, 506.4 | I27.8, I27.9, J40.x–J47.x, J60.x–J67.x, J68.4, J70.1, J70.3 |
Congestive heart failure
| 428.x | I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.5–I42.9, I43.x, I50.x, P29.0 |
PVD
| 441.x, 443.9, 785.4, V43.4 | I70.x–I71.x, I73.1–I73.9, I77.1, I79.0, I79.2, K55.1, K55.8, K55.9, Z95.8, Z95.9 |
Liver/GI
| ||
Mild Liver Disease
| 571.2, 571.5, 571.6, 571.4 | B18.x, K70.0–K70.3, K70.9, K71.3–K71.5, K71.7, K73.x, K74.x, K76.0, K76.2–K76.4, K76.8, K76.9, Z94.4 |
Peptic Ulcer Disease
| 531x–534.x | K25–-K28.x |
Moderate Severe Liver Disease
| 572.2, 572.3, 572.4, 572.8, 456.0–456.21 | I85.0, I85.9, I86.4, I98.2, K70.4, K71.1, K72.1, K72.9, K76.5–K76.7 |
Renal disease
| 582.x, 583.x, 584.x, 585.x, 586.x, 588.x | I12.0, I13.1, N03.2–N03.7, N05.2–N05.7, N18.x, N19.x, N25.0, Z49.0–Z49.2, Z94.0, Z99.2 |
Malignancy/Metastatic disease
| 140.x–172.x, 174.x–208.x | C00.x–C26.x, C30.x–C34.x, C37.x–C41.x, C43.x, C45.x–C58.x, C60.x–C76.x, C77.x–C80.x, C81.x–C85.x, C88.x, C90.x–C97.x |
Hypertension
| 401.x–405.x | I10.x, I11.x–I13.x, I15.x |
Hyperlipidemia
| 272.0, 272.1, 272.2, 272.3, 272.4 | E78.0–E78.5 |
Dialysis
| V42.0, V45.1, V56.0, V56.1, V56.8, 39.27, 39.42, 39.93–39.95, 54.98 | Z49.x, Z99.2 Procedure codes: 1.KY.76, 1.OT.53, 1.PZ.21 |
Diabetes Type 1
| 250.0 – 250.9 with 5th digits 1 & 3 | E10.x, E13.10, E13.12, E14.10, E14.12 |
Diabetes Type 2
| 250.0 – 250.9 with 5th digits 0 & 2 | E11.x, E13.0, E14.0 |
Current Smoker
| 305.10, 305.11, 305.12 | F17.x, T65.2, Z50.8, Z71.6, Z72.0, P04.2 Procedure codes*: 5.AD.14.BK, 7.SP.10.VK |
Prior MI
| 412.x | I25.2 |
INDICATION | ||
MI
| 410.x | I21.x–I23.x |
Unstable angina
| 411.1, 413.0, 411.89, 411.81 | I20.0, I24.x |
Stable angina
| 413.1, 413.9 | I20.8, I20.9, I25.0, I25.1, I25.8, I25.9 |
Other
| None of the above codes for indication present | None of the above codes for indication present |
Prior CABG
| V45.81 | Z95.1 |
Prior PCI
| V45.82 | Z95.5 |
Summary of Methodology
Results
Coding Algorithm
Pattern of missing data
FISCAL YEAR | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ICD-9-CM | ICD-10 | |||||||||||
CLINICAL VARIABLES | TOTAL | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 |
N
|
86,649
|
6,348
|
6,131
|
6,242
|
6,718
|
8,110
|
8,469
|
8,479
|
8,767
|
8,835
|
9,257
|
9,293
|
Dialysis (%)
|
11.5
| 4.7 | 2.8 | 2.5 | 3.6 | 4.9 | 2.1 | 24.1 | 11.0 | 20.7 | 21.5 | 18.2 |
Diabetes Type I (%)
|
6.5
| 4.7 | 2.8 | 2.5 | 3.6 | 2.9 | 0.9 | 14.4 | 8.8 | 7.8 | 10.0 | 9.2 |
Renal (Creatinine > 200 mmol/L) (%)
|
29.8
| 20.8 | 12.7 | 15.3 | 28.8 | 59.5 | 43.2 | 32.3 | 26.7 | 25.1 | 24.6 | 30.0 |
Malignancy/Metastatic Disease (%)
|
10.4
| 7.0 | 5.7 | 5.9 | 5.9 | 5.1 | 2.1 | 20.5 | 17.7 | 14.4 | 11.7 | 13.5 |
Prior CABG (%)
|
9.2
| 20.8 | 11.1 | 10.4 | 10.9 | 12.2 | 6.3 | 1.1 | 0.1 | 10.0 | 12.4 | 10.3 |
Liver/GI (%)
|
11.1
| 0.2 | 0.1 | 5.4 | 5.9 | 5.1 | 2.1 | 39.1 | 16.4 | 13.2 | 11.3 | 13.8 |
Prior PCI (%)
|
9.3
| 19.3 | 11.3 | 10.1 | 11.0 | 12.7 | 6.6 | 1.2 | 0.2 | 10.0 | 12.8 | 12.1 |
Cerebrovascular Disease (%)
|
10.8
| 4.7 | 2.8 | 2.5 | 3.6 | 4.9 | 2.1 | 11.9 | 11.3 | 21.3 | 23.7 | 20.1 |
PVD (%)
|
10.4
| 4.7 | 2.8 | 2.5 | 3.6 | 4.9 | 2.1 | 12.0 | 11.3 | 21.4 | 21.0 | 18.6 |
Pulmonary Disease (%)
|
9.3
| 7.0 | 5.7 | 5.9 | 5.9 | 5.1 | 2.1 | 17.6 | 14.2 | 11.7 | 11.0 | 12.5 |
Congestive heart failure (%)
|
14.1
| 20.6 | 17.3 | 8.3 | 10.7 | 16.0 | 10.2 | 12.5 | 10.8 | 17.2 | 17.5 | 14.4 |
Diabetes Type II (%)
|
6.7
| 4.7 | 2.8 | 2.5 | 3.6 | 2.9 | 0.9 | 14.7 | 8.9 | 7.6 | 10.3 | 10.1 |
Prior MI (%)
|
15.8
| 19.3 | 15.9 | 9.5 | 12.2 | 16.6 | 11.4 | 17.7 | 18.2 | 19.1 | 17.5 | 14.9 |
Hypertension (%)
|
11.2
| 14.9 | 12.4 | 7.8 | 10.8 | 15.1 | 10.9 | 11.5 | 10.0 | 8.7 | 12.2 | 9.3 |
Hyperlipidemia (%)
|
17.4
| 28.0 | 26.8 | 19.9 | 20.8 | 22.7 | 17.1 | 14.8 | 12.9 | 13.2 | 12.1 | 11.0 |
Proportion with one or more missing
|
58.9
| 48.2 | 45.8 | 39.5 | 49.5 | 72.3 | 58.3 | 74.1 | 60.0 | 64.8 | 60.2 | 61.3 |
Percentage of the clinical conditions
FISCAL YEAR | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ICD-9-CM | ICD-10 | |||||||||||
VARIABLE | TOTAL | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 |
N
|
86,649
| 6,348 | 6,131 | 6,242 | 6,718 | 8,110 | 8,469 | 8,479 | 8,767 | 8,835 | 9,257 | 9,293 |
Mean Age (Std. Dev.)
|
62.6 (12.0)
| 62.0 (11.4) | 62.6 (11.5) | 62.7 (11.4) | 62.7 (11.7) | 62.7 (12.1) | 62.6 (12.1) | 62.6 (12.0) | 62.6 (12.3) | 62.6 (12.5) | 62.5 (12.4) | 63.1 (12.4) |
Percent > 75 years
|
16.6
| 12.4 | 14.4 | 14.7 | 15.1 | 17.0 | 17.0 | 17.0 | 17.3 | 17.8 | 18.5 | 18.9 |
Percent Male
|
69.4
| 70.2 | 70.6 | 69.7 | 70.5 | 68.4 | 69.6 | 68.2 | 69.7 | 68.8 | 69.6 | 69.2 |
Comorbidities
| ||||||||||||
Dialysis
|
1.6
| 0.8 | 1.3 | 1.5 | 1.7 | 1.4 | 1.7 | 1.9 | 1.8 | 1.7 | 1.8 | 1.4 |
Diabetes Type I
|
1.8
| 2.2 | 1.7 | 1.4 | 1.1 | 1.3 | 1.3 | 1.9 | 2.7 | 1.7 | 2.0 | 1.7 |
Renal (Creatinine > 200 mmol/L)
|
3.5
| 2.0 | 2.2 | 2.3 | 2.9 | 2.4 | 3.3 | 3.3 | 4.4 | 5.0 | 3.9 | 4.9 |
Malignancy
|
4.0
| 2.3 | 3.1 | 3.6 | 3.8 | 4.1 | 4.4 | 4.3 | 4.4 | 4.0 | 4.4 | 4.4 |
Prior CABG
|
5.4
| 7.8 | 7.5 | 7.3 | 8.8 | 7.1 | 5.2 | 4.8 | 4.0 | 3.5 | 3.2 | 3.2 |
Liver/GI
|
5.7
| 2.4 | 3.0 | 3.5 | 3.9 | 4.7 | 4.1 | 4.4 | 7.8 | 7.7 | 8.8 | 8.6 |
Prior PCI
|
6.5
| 12.0 | 9.8 | 9.3 | 9.1 | 7.2 | 6.3 | 4.9 | 4.8 | 4.3 | 4.1 | 4.3 |
Cerebrovascular Disease
|
6.7
| 4.9 | 5.1 | 6.3 | 7.2 | 7.3 | 7.2 | 7.2 | 7.1 | 6.9 | 6.8 | 7.0 |
PVD
|
7.8
| 6.1 | 6.3 | 7.7 | 8.4 | 8.6 | 8.3 | 7.9 | 9.1 | 7.1 | 7.4 | 7.8 |
COPD
|
13.6
| 8.0 | 7.3 | 9.7 | 11.1 | 12.9 | 12.7 | 15.1 | 15.2 | 17.7 | 17.2 | 17.0 |
Congestive heart failure
|
14.7
| 13.4 | 13.5 | 14.5 | 15.1 | 15.4 | 16.0 | 14.9 | 16.0 | 15.5 | 11.9 | 15.0 |
Diabetes Type II
|
19.8
| 15.4 | 15.4 | 18.3 | 18.2 | 18.3 | 19.4 | 20.3 | 21.5 | 22.4 | 21.3 | 23.1 |
Current Smoker
|
26.5
| 25.4 | 23.7 | 26.0 | 25.1 | 25.9 | 27.9 | 27.6 | 26.8 | 26.9 | 27.1 | 27.8 |
Prior MI
|
45.5
| 50.0 | 46.9 | 51.3 | 48.0 | 45.4 | 46.9 | 42.3 | 45.4 | 44.4 | 32.7 | 51.8 |
Hypertension
|
57.4
| 50.4 | 51.4 | 49.0 | 50.4 | 49.8 | 56.6 | 57.2 | 60.3 | 66.4 | 63.2 | 66.8 |
Hyperlipidemia
|
59.9
| 37.0 | 38.5 | 44.2 | 49.5 | 50.4 | 54.7 | 65.0 | 71.1 | 73.9 | 76.7 | 75.7 |
INDICATION FOR CATH
| ||||||||||||
Stable Angina
|
31.4
| 29.4 | 30.9 | 29.7 | 31.0 | 29.1 | 27.6 | 28.2 | 34.0 | 34.1 | 33.7 | 35.3 |
Unstable Angina
|
25.6
| 31.7 | 29.1 | 27.5 | 26.2 | 26.4 | 27.8 | 26.2 | 24.2 | 24.5 | 27.5 | 14.3 |
MI
|
31.6
| 21.0 | 23.7 | 30.8 | 29.0 | 28.1 | 30.9 | 32.3 | 35.0 | 35.0 | 31.7 | 43.2 |
Other
|
11.5
| 17.9 | 16.4 | 12.1 | 13.7 | 16.4 | 13.7 | 13.4 | 6.8 | 6.5 | 7.1 | 7.2 |