Abstract
Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.
Similar content being viewed by others
Abbreviations
- AD:
-
Atopic dermatitis
- PHQ:
-
Patient Health Questionnaire
- OR:
-
Odds ratio
- aOR:
-
Adjusted odds ratio
- EASI:
-
Eczema area severity index
- Freq:
-
Frequency
- LCL:
-
Lower confidence limit
- UCL:
-
Upper confidence limit
- Cl:
-
Confidence limit
- ICD-10-CM:
-
International classification of disease tenth edition clinical modification
- PPV:
-
Positive predictive value
- NPV:
-
Negative predictive value
References
Hsu D, Dalal P, Sable K et al (2017) Validation of international classification of disease ninth revision codes for atopic dermatitis. Allergy 72(7):1091–1095
Narla S, Silverberg J (2021) Dermatology for the internist: optimal diagnosis and management of atopic dermatitis. Annals Med 53(1):2165–2177
Croce E, Lopes F, Ruth J, Silverberg J (2021) Interventions to improve primary care provider management of atopic dermatitis: a systematic review. Pediatric Dermatol 38(5):1004–1011
Eichenfield L, Tom W, Chamlin S et al (2014) Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 70(2):338–351
Williams H, Burney PG, Pembroke AC, Hay RJ (1994) The U.K. Working Party’s diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol 131(3):406–416
Funding
None declared.
Author information
Authors and Affiliations
Contributions
SI and ES performed data collection. SI and NP performed data analysis. SI and JIS wrote the main manuscript text and prepared figures. All authors contributed to data interpretation and reviewed the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
No other authors have any relevant conflicts of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Iyer, S., Patel, N., Sanfilippo, E. et al. Assessment of the validity of international classification of disease tenth revision codes for atopic dermatitis. Arch Dermatol Res 315, 879–884 (2023). https://doi.org/10.1007/s00403-022-02435-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02435-y