Validation of ICD-10 and CPT Codes to Identify Acute Esophageal Variceal Hemorrhage and Band Ligation among Patients with Liver Cirrhosis

Abstract

Background & Aim: Claims databases are used ever more widely in medical research. The building blocks of such databases are the ICD-10 CM codes, which are used to identify study patients, exposures and procedures. We aimed to determine the performance characteristics of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) and the current procedural terminology (CPT) coding systems in identifying patients with acute esophageal variceal hemorrhage and esophageal variceal band ligation. Methods: Both liver cirrhosis and acute gastrointestinal hemorrhage were ascertained using manual electronical medical record review. The study patients’ billing records were obtained and searched for ICD-10 CM code I85.xx for esophageal variceal hemorrhage and 06L34CZ, 06L38CZ and CPT code 43244 for esophageal variceal band ligation. Results: 1,231 patient encounters were included. Alcohol was the most common etiology for liver cirrhosis (62.3%), and hematemesis (40.5%) was the most common patient presentation. A principal diagnosis ICD-10 CM code of I85.xx was associated with high sensitivity (84.8%), specificity (88.6%), positive (PPV, 92.9%) and negative (NPV, 77.0%) predictive values for presence of esophageal varices. For esophageal variceal band ligation, the ICD-10 CM had lower sensitivity than the CPT codes (51% versus 77%, respectively). However, both systems had similar specificity (99% and 99%), positive (97% and 96%), and negative (86% and 93%) predictive values in this setting. Conclusion: ICD-10 CM diagnostic code I85.xx and procedure codes 06L34CZ and 06L38CZ as well as CPT code 43244 accurately identified patients with acute esophageal variceal hemorrhage and esophageal variceal band ligation, respectively.