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Development and Validation of an Algorithm to Classify as Equivalent the Procedures in ICD-10-PCS That Differ Only by Laterality

Epstein, Richard H. MD*; Dexter, Franklin MD, PhD, FASA; O’Neill, Liam PhD

doi: 10.1213/ANE.0000000000003340
Technology, Computing, and Simulation: Original Clinical Research Report

BACKGROUND: The switch from International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for coding of inpatient procedures in the United States increased the number of procedural codes more than 19-fold, in large part due to the addition of laterality. We examined ICD-10-PCS codes for pairs of mirror-image procedures that are surgically equivalent.

METHODS: We developed an algorithm in structured query language (SQL) to identify ICD-10-PCS codes differing only by laterality. We quantified the impact of laterality on the number of commonly performed major therapeutic procedures (ie, surgical diversity) using 2 quarters of discharge abstracts from Texas.

RESULTS: Of the 75,789 ICD-10-PCS codes from federal fiscal year 2017, 16,839 (22.3%) pairs differed only by laterality (with each pair contributing 2 codes). With the combining of equivalent codes, diversity in the state of Texas decreased from 78.2 to 74.1 operative procedures (95% confidence interval, 5.1 to −3.1; P < .001).

CONCLUSIONS: Our algorithm identifies ICD-10-PCS codes that differ only by laterality. However, laterality had a small effect on surgical diversity among major therapeutic procedures. Our SQL code and the lookup table will be useful for all US inpatient analyses of ICD-10-PCS surgical data, because combining procedures differing only by laterality will often be desired.

From the *Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, Miami, Florida

Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa

Department of Health Behavior and Health Systems, School of Public Health University of North Texas-Health Science Center, Fort Worth, Texas.

Published ahead of print 16 February 2018.

Accepted for publication February 16, 2018.

Funding: Departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Richard H. Epstein, MD, Department of Anesthesiology, Pain Management and Perioperative Medicine, 1400 NW 12th Ave, Suite 3075, Miami, FL 33136. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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