Abstract 17709: ICD-10 Codes Have Low Sensitivity and Suboptimal Positive Predictive Value for Identifying Cases of Pulmonary Embolism With Cor Pulmonale in Electronic Healthcare Records

Abstract

Introduction: The International Classification of Diseases, 10 th revision (ICD-10) codes were updated in 2015 to include designation of pulmonary embolism (PE) with cor pulmonale . These codes can be advantageous to identify higher-risk patients with PE for research or quality improvement. However, the validity of these codes is unknown. Methods: We reviewed patient data from Mass General Brigham (MGB) health system (01/2016-12/2021). Patients were randomly selected from 3 groups: Patients with Principal discharge diagnosis codes for PE, patients with secondary discharge diagnosis of PE, and patients with no PE codes. Accuracy of codes for PE with cor pulmonale were assessed with reference to manual review by 2 independent physicians using pre-specified criteria. Weighted estimates were obtained by considering the total number of hospitalizations. Results: 1,712 patients were included (age: 60.6±17.8 years, 52.3% female). Chart review found 865 patients with PE, of whom 360 (41.6%) had PE with cor pulmonale according to predefined clinical criteria. Of these 360 PE patients, 358 (99.4%) had ICD-10 codes for PE. However, only in 36 (10.1%) cases, the specific cor pulmonale codes were used. There were 24 additional cases with ICD-10 codes for PE with cor pulmonale in whom the diagnosis was not confirmed per manual review. Sensitivity and specificity for PE with cor pulmonale codes in Principal-or-secondary position were 10.0% and 98.2% (Table, panel A). The positive predictive value (PPV) for PE with cor pulmonale in Principal-or-secondary discharge position was 63.2% in the weighted sample (Table, panel B). Conclusions: ICD-10 codes for identification of acute PE with cor pulmonale have excellent specificity, but very poor sensitivity and suboptimal PPV. These results are informative for investigators who may use such ICD-10 codes for research or quality improvement purposes.