Validation of the ICD-11 beta draft in hand surgery

Abstract

The practice of hand surgery is characterised by the surgical and conservative treatment of patients with a broad range of single and multiple hand injuries, many of them complex, as well as hand diseases. Thus far, the coding of especially complex hand injuries using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (German Modification) (ICD-10-GM) has often been a challenge for the persons responsible for coding. To ensure an exact, unambiguous and reliable coding of patient cases, the mapping of these cases in the 11th revision of the ICD is an inevitable requirement. The aim of this study was to examine the representation of hand injuries and diseases in the ICD-11 beta draft. We performed a case-oriented validation study. Based on real-life patient cases, we developed two types of case scenarios (short diagnostic statements: "lines", and more comprehensive case descriptions: "cases"), which were coded using the ICD-11 beta draft. To gain insight into participants' experiences with the coding process, additional telephone interviews were carried out. Twenty-three hand surgeons from nine participating institutions coded a total of 315 case scenarios using the ICD-11 beta draft - 210 lines and 105 cases. An inter-rater reliability (Krippendorff's alpha) of 0.67 for both lines and cases indicated substantial agreement between the coding physicians. Study participants reported difficulties with coding in approximately one third of case scenarios (lines: 27 % and cases: 35 %). Nine physicians additionally took part in telephone interviews. Problems with coding using the ICD-11 beta draft as well as specific suggestions for changes were collected, verified by a working group and complemented by further proposals. The results of this study entailed important adaptations of the ICD-11 in the field of hand surgery and will in future enable an unambiguous and specific coding of hand injuries and diseases, especially multiple injuries. The obtained inter-rater reliability for the ICD-11 beta draft is satisfactory. Specific problems as well as proposals for changes supported the finalisation of the ICD-11.