Use of ICD-10 diagnosis codes to identify seropositive and seronegative rheumatoid arthritis when lab results are not available

Arthritis Research & Therapy

Hong Zhou¹  David Salchert¹  Fenglong Xie¹  Huifeng Yun²  Jeffrey R. Curtis³ 

[1] Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA;Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA;Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA;Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA;Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA;Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL, USA;

关键词: Rheumatoid arthritis;    Electronic health records;    Algorithm;    Claims data;    Validity;    ICD-10;   

DOI  :  10.1186/s13075-020-02310-z

来源: Springer

【 摘 要 】

BackgroundRheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody tests are often measured at the time of rheumatoid arthritis (RA) diagnosis but may not be repeated and therefore not available in electronic health record (EHR) data; lab test results are unavailable in most administrative claims databases. ICD10 coding allows discrimination between rheumatoid factor positive (M05) (“seropositive”) and seronegative (M06) patients, but the validity of these codes has not been examined.MethodsUsing the ACR’s Rheumatology Informatics System for Effectiveness (RISE) EHR-based registry and U.S. MarketScan data where some patients have lab test results, we assembled two cohorts. Seropositive RA was defined having a M05 diagnosis code on the second rheumatologist encounter, M06 similarly identified seronegative RA, and RF and anti-CCP lab test results were the gold standard. We calculated sensitivity (Se) and positive predicted value (PPV) of the M05/M06 diagnosis codes.ResultsWe identified 43,581 eligible RA patients (RISE) and 1185 (MarketScan) with RF or anti-CCP lab test results available. Using M05 as the proxy for seropositive RA, sensitivity = 0.76, PPV = 0.82 in RISE, and Se = 0.73, PPV = 0.84 in MarketScan. Results for M06 as a proxy for seronegative RA were comparable in RISE, albeit somewhat lower in MarketScan. Over 3 consecutive visits, approximately 90% of RA patients were coded consistently using either M05 or M06 at each visit.ConclusionUnder ICD10, M05 and M06 diagnosis codes are reasonable proxies to identify seropositive and seronegative RA with high sensitivity and positive predictive values if lab test results are not available.

【 授权许可】

CC BY