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Reliability of International Classification of Disease-9 Versus International Classification of Disease-10 Coding for Proximal Femur Fractures at a Level 1 Trauma Center

Schneble, Christopher A. MD; Natoli, Roman M. MD, PhD; Schonlau, Duane L. MD; Reed, R. Lawrence MD; Kempton, Laurence B. MD

Journal of the American Academy of Orthopaedic Surgeons: April 08, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-17-00874
Research Article: PDF Only

Introduction: The Centers for Medicare & Medicaid services proposed that transitioning from the 9th to the 10th revision of the International Classification of Disease (ICD) would provide better data for research. This study sought to determine the reliability of ICD-10 compared with ICD-9 for proximal femur fractures.

Methods: Available imaging studies from 196 consecutively treated proximal femur fractures were retrospectively reviewed and assigned ICD codes by three physicians. Intercoder reliability (ICR) was calculated. Collectively, the physicians agreed on what should be the correct codes for each fracture, and this was compared with coding found in the medical and billing records.

Results: No significant difference was observed in ICR for both ICD-9 and ICD-10 exact coding, which were both unreliable. Less specific coding improved ICR. ICD-9 general coding was better than ICD-10. Electronic medical record coding was unreliable. Billing codes were also unreliable, yet ICD-10 was better than ICD-9.

Discussion: ICD-9 and ICD-10 lack reliability in coding proximal femur fractures. ICD-10 results in data that are no more reliable than those found with ICD-9.

Level of Evidence: Level I diagnostic

From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Dr. Schneble), the Department of Orthopaedic Surgery (Dr. Natoli), the Department of Radiology (Dr. Schonlau), the Department of Surgery (Dr. Reed), Indiana University School of Medicine, Indianapolis, IN, and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC (Dr. Kempton).

Correspondence to Dr. Kempton: Laurence.Kempton@AtriumHealth.org

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Schneble, Dr. Natoli, Dr. Schonlau, Dr. Reed, and Dr. Kempton.

© 2019 by American Academy of Orthopaedic Surgeons
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