Survey of ICD-10 coding of hospital admissions in the UK due to recreational drug toxicity

Abstract

Hospital admissions for acute recreational drug toxicity are coded using the International Classification of Diseases (ICD-10) coding system. It is unclear how these admissions are coded, as often there are no specific ICD-10 codes for the drug(s) involved. This study was undertaken to determine how acute recreational drug toxicity admissions are routinely coded. Questionnaire survey. Questionnaires were sent to clinical coding departments in all England and Wales acute National Health Service Trusts, comprising of 12 hypothetical discharge summaries (4 acute recreational drug toxicity for which there are no appropriate ICD-10 codes, 5 other toxicological presentations with appropriate ICD-10 codes available and 3 control medical admissions), and they were asked to code these discharge summaries. Seventy responses were received. Discharge summaries relating to acute recreational drug toxicity without appropriate ICD-10 codes, had a wider range of diagnostic codes used (7-19 primary codes per summary) compared to control/alcohol discharge summaries (1-4 per summary). Additionally, often the codes did not refer to recreational drugs in those summaries relating to acute recreational drug toxicity. Hospital admissions due to recreational drugs without specific ICD-10 codes are assigned a wide variety of primary codes and/or the use of recreational drugs may not be coded. Further work is needed to look at methods of capturing presentations to hospital with acute recreational drug toxicity, either by updating the ICD codes or using a more time-responsive data capture system in sentinel hospitals in the UK to monitor trends in acute recreational drug toxicity.