Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes Via Regional Diagnosis Heterogeneity

Overview

Journal Ann Fam Med

Date 2025 Jan 27

PMID 39870533

Authors

Marcin Piotr Walkowiak

Dariusz Walkowiak

Jaroslaw Walkowiak

Affiliations

Soon will be listed here.

Abstract

Purpose: We aimed to analyze regional variations in the assignment of (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition.

Methods: We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses.

Results: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis).

Conclusions: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning.

References

Weinberger D, Chen J, Cohen T, Crawford F, Mostashari F, Olson D . Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020. JAMA Intern Med. 2020; 180(10):1336-1344. PMC: 7330834. DOI: 10.1001/jamainternmed.2020.3391. View

Beckman K . Coding Common Respiratory Problems in ICD-10. Fam Pract Manag. 2014; 21(6):17-22. View

Hordijk P, Broekhuizen B, Butler C, Coenen S, Godycki-Cwirko M, Goossens H . Illness perception and related behaviour in lower respiratory tract infections—a European study. Fam Pract. 2014; 32(2):152-8. PMC: 4371890. DOI: 10.1093/fampra/cmu075. View

Kohane I, Aronow B, Avillach P, Beaulieu-Jones B, Bellazzi R, Bradford R . What Every Reader Should Know About Studies Using Electronic Health Record Data but May Be Afraid to Ask. J Med Internet Res. 2021; 23(3):e22219. PMC: 7927948. DOI: 10.2196/22219. View

McCollum E, Park D, Watson N, Buck W, Bunthi C, Devendra A . Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1-59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case-control study. BMJ Open Respir Res. 2017; 4(1):e000193. PMC: 5531306. DOI: 10.1136/bmjresp-2017-000193. View

Cimino J . Desiderata for controlled medical vocabularies in the twenty-first century. Methods Inf Med. 1998; 37(4-5):394-403. PMC: 3415631. View

Peng M, Eastwood C, Boxill A, Jolley R, Rutherford L, Carlson K . Coding reliability and agreement of International Classification of Disease, 10 revision (ICD-10) codes in emergency department data. Int J Popul Data Sci. 2020; 3(1):445. PMC: 7299481. DOI: 10.23889/ijpds.v3i1.445. View

Walkowiak M, Walkowiak D . Underestimation in Reporting Excess COVID-19 Death Data in Poland during the First Three Pandemic Waves. Int J Environ Res Public Health. 2022; 19(6). PMC: 8954142. DOI: 10.3390/ijerph19063692. View

Yoon Y, Park C, Kim J, Hwang K, Lee S, Kim T . Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother. 2018; 49(4):326-352. PMC: 5754344. DOI: 10.3947/ic.2017.49.4.326. View

10.

Valentine J, Gillespie E, Verspoor K, Hall L, Worth L . Performance of ICD-10-AM codes for quality improvement monitoring of hospital-acquired pneumonia in a haematology-oncology casemix in Victoria, Australia. Health Inf Manag. 2022; 53(2):112-120. DOI: 10.1177/18333583221131753. View

11.

Hek K, van Esch T, Lambooij A, Weesie Y, van Dijk L . Guideline Adherence in Antibiotic Prescribing to Patients with Respiratory Diseases in Primary Care: Prevalence and Practice Variation. Antibiotics (Basel). 2020; 9(9). PMC: 7559889. DOI: 10.3390/antibiotics9090571. View

12.

Goldstein E, Viboud C, Charu V, Lipsitch M . Improving the estimation of influenza-related mortality over a seasonal baseline. Epidemiology. 2012; 23(6):829-38. PMC: 3516362. DOI: 10.1097/EDE.0b013e31826c2dda. View

13.

Colicchio T, Cimino J, Del Fiol G . Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era. J Med Internet Res. 2019; 21(6):e13313. PMC: 6682280. DOI: 10.2196/13313. View

14.

Walkowiak M, Walkowiak D . From respiratory diseases to nervous system disorders: Unraveling the certified causes of influenza-associated deaths in Poland from 2000 to 2019. Influenza Other Respir Viruses. 2023; 17(11):e13214. PMC: 10640960. DOI: 10.1111/irv.13214. View

15.

Goossens H, Ferech M, Vander Stichele R, Elseviers M . Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005; 365(9459):579-87. DOI: 10.1016/S0140-6736(05)17907-0. View

16.

Monto A, Malosh R, Petrie J, Thompson M, Ohmit S . Frequency of acute respiratory illnesses and circulation of respiratory viruses in households with children over 3 surveillance seasons. J Infect Dis. 2014; 210(11):1792-9. PMC: 4296188. DOI: 10.1093/infdis/jiu327. View

17.

Martinez K, Rood M, Rothberg M . Coding Bias in Respiratory Tract Infections May Obscure Inappropriate Antibiotic Use. J Gen Intern Med. 2019; 34(6):806-808. PMC: 6544729. DOI: 10.1007/s11606-018-4823-x. View

18.

Guerrisi C, Turbelin C, Blanchon T, Hanslik T, Bonmarin I, Levy-Bruhl D . Participatory Syndromic Surveillance of Influenza in Europe. J Infect Dis. 2017; 214(suppl_4):S386-S392. DOI: 10.1093/infdis/jiw280. View

19.

Wabe N, Li L, Lindeman R, Post J, Dahm M, Li J . Evaluation of the accuracy of diagnostic coding for influenza compared to laboratory results: the availability of test results before hospital discharge facilitates improved coding accuracy. BMC Med Inform Decis Mak. 2021; 21(1):168. PMC: 8141245. DOI: 10.1186/s12911-021-01531-9. View

20.

Walkowiak M, Walkowiak D . Am I Paid Well Enough to Be Diagnosed with COVID-19? Determinants of Gender Differences in Infection Detection Rate among Polish Working Age Population. J Pers Med. 2022; 12(5). PMC: 9147074. DOI: 10.3390/jpm12050793. View