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ICD codes are already used to mark CKD staging, and examination of a patient’s coding history may reveal whether the patient is rapidly progressing towards ESRD. Such patients benefit from targeted care aimed at maximizing therapy available to delay onset of ESRD.
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Precise diagnosis of rapidly progressing CKD patients is of critical importance. The United States Renal Disease System (USRDS) estimates that over thirty-million Americans are affected by CKD, yet fewer than 800,000 have progressed to end stage renal disease (ESRD). These studies, however, are typically based on inpatient data, leaving the more reliable outpatient data insufficiently examined.
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Deficiency of ICD codes in identifying CKD patients and their stage of disease is well described, with other studies reporting low sensitivities and high specificities. Coding accuracy in conditions such as cardiovascular diseases, stroke, or pneumococcal pneumonia is generally accurate, unlike that of Chronic Kidney Disease (CKD). However, studies designed to examine the agreement of ICD coding with gold-standard clinical markers have shown mixed accuracy of ICD codes depending on disease. Ĭonsequently, ensuring that reported ICD codes accurately reflect patient diagnoses is of critical importance to the entire medical community. Insurance providers also use ICD codes as a basis for reimbursement. Information derived from ICD codes provides the basis of mortality and morbidity statistics that inform the medical community of the burden of disease on the population such data serves a vital role in determining resource allocation and related medical policy. The International Classification of Diseases (ICD) coding system is the standard tool used by physicians, researchers, insurance providers, and administrators to classify diseases for clinical and epidemiological purposes. This analysis further defines the limitations of ICD codes in addressing diagnosis of disease severity or disease progression for clinical or epidemiological purposes. This study depicts the novel finding that ICD-codes display poor capacity to identify rapidly progressing CKD patients when compared to gold standard eGFR measures, and further demonstrates the limitations of coding in CKD diagnosis. Of 28,762 laboratory-confirmed CKD patients, 9249 had a qualifying ICD code, for a sensitivity of 16% with PPV of 63.10% Of 187,767 patients with laboratory-confirmed absence of CKD, 182,359 also did not have a qualifying ICD code, for a specificity of 97.12% with NPV of 90.33%. CKD-staging ICD codes identified 83 of these, for a sensitivity of 25.7% with positive predictive value (PPV) of 13.74%, and specificity 95.09% with negative predictive value (NPV) of 97.68%. Of 10,927 clinically identified CKD patients qualifying for inclusion in the progression analysis, 323 were clinically identified as rapid progressors. The diagnosis of CKD using eGFR was also compared to diagnosis using a set of CKD related ICD codes. Rapid progressors, defined as those with yearly estimated glomerular filtration rate (eGFR) loss greater than 4 ml/min/1.73m 2) were identified. The progression of CKD using a serum creatinine based longitudinal mixed-model was contrasted with that documented by CKD-staging ICD codes.
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Serial observations including outpatient serum creatinine measurements collected from 2007 through 2014 of 216,529 patients were examined. Our study evaluated the diagnostic accuracy of CKD-staging ICD codes among CKD patients from a large insurer database in identifying individuals rapidly progressing towards end-stage renal disease (ESRD). However, ICD codes are often not assigned or incorrectly given, particularly among Chronic Kidney disease (CKD) patients.
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The International Classification of Diseases (ICD) coding system is the industry standard tool for billing, disease classification, and epidemiology purposes.