Updated Diagnosis Codes Suggest Opioid-Related Hospitalization Rates Higher Than Previously Estimated

A new AHRQ analysis based on updated International Classification of Diseases (ICD) codes suggests that opioid-related hospitalization rates during 2015-16 were substantially higher than previously estimated. The U.S. health system transitioned from ICD-9 to ICD-10 codes on Oct. 1, 2015, a shift that increased the overall number of possible diagnosis codes from about 14,000 to 68,000. That transition included 14 new codes for “opioid use, unspecified” that captured an additional 7,500 opioid-related hospitalizations, according to the AHRQ study, published in the journal Medical Care. Authors of the study concluded that the new ICD-10 coding system may lead to better estimates of the burden of opioid problems in the hospital sector, as well as better tracking of the potential impact of federal, state and local policies aimed at addressing the epidemic. Access the abstract.

2017 Sep 19. doi: 10.1097/MLR.0000000000000805. [Epub ahead of print]

Trends in Opioid-related Inpatient Stays Shifted After the US Transitioned to ICD-10-CM Diagnosis Coding in 2015.

Heslin KC1, Owens PL, Karaca Z, Barrett ML, Moore BJ, Elixhauser A.

Author information

Abstract

BACKGROUND:

Trend analyses of opioid-related inpatient stays depend on the availability of comparable data over time. In October 2015, the US transitioned diagnosis coding from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM, increasing from ∼14,000 to 68,000 codes. This study examines how trend analyses of inpatient stays involving opioid diagnoses were affected by the transition to ICD-10-CM.

SUBJECTS:

Data are from Healthcare Cost and Utilization Project State Inpatient Databases for 14 states in 2015-2016, representing 26% of acute care inpatient discharges in the US.

STUDY DESIGN:

We examined changes in the number of opioid-related stays before, during, and after the transition to ICD-10-CM using quarterly ICD-9-CM data from 2015 and quarterly ICD-10-CM data from the fourth quarter of 2015 and the first 3 quarters of 2016.

RESULTS:

Overall, stays involving any opioid-related diagnosis increased by 14.1% during the ICD transition-which was preceded by a much lower 5.0% average quarterly increase before the transition and followed by a 3.5% average increase after the transition. In stratified analysis, stays involving adverse effects of opioids in therapeutic use showed the largest increase (63.2%) during the transition, whereas stays involving abuse and poisoning diagnoses decreased by 21.1% and 12.4%, respectively.

CONCLUSIONS:

The sharp increase in opioid-related stays overall during the transition to ICD-10-CM may indicate that the new classification system is capturing stays that were missed by ICD-9-CM data. Estimates of stays involving other diagnoses may also be affected, and analysts should assess potential discontinuities in trends across the ICD transition.

PMID:

28930890

DOI:

10.1097/MLR.0000000000000805