Assessing Validity of ICD-10 Administrative Data in Coding Comorbidities
Bibliographic record
Abstract
Objectives: Administrative data is commonly used to inform chronic disease prevalence and support health informatics research. This study assessed the validity of coding comorbidity in the International Classification of Diseases, 10th Revision (ICD-10) administrative data. Methods: We analyzed three chart review cohorts (4,008 patients in 2003, 3,045 in 2015, and 9,024 in 2022) in Alberta, Canada. Nurse reviewers assessed the presence of 17 clinical conditions using a consistent protocol. The reviews were linked with administrative data using unique identifiers. We compared the accuracy in coding comorbidity by ICD-10, using chart review data as the reference standard. Results: Our findings showed that the mean difference in prevalence between chart reviews and ICD-10 for these 17 conditions was 2.1% in 2003, 7.6% in 2015, and 6.3% in 2022. Some conditions were relatively stable, such as diabetes (1.9%, 2.1%, and 1.1%) and metastatic cancer (0.3%, 1.1%, and 0.4%). For these 17 conditions, the sensitivity ranged from 39.6-85.1% in 2003, 1.3-85.2% in 2015, and 3.0-89.7% in 2022. The C-statistics for predicting in-hospital mortality using comorbidities by ICD-10 were 0.84 in 2003, 0.81 in 2015, and 0.78 in 2022. Discussion: The under-coding could be primarily due to the increase of hospital patient volumes and the limited time allocated to coders. There is a potential to develop artificial intelligence methods based on electronic health records to support coding practices and improve coding quality. Conclusion: Comorbidities were increasingly under-coded over 20 years. The validity of ICD-10 decreased but remained relatively stable for certain conditions mandated for coding. The under-coding exerted minimal impact on in-hospital mortality prediction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.118 | 0.356 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".