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Uptake and Accuracy of the Diagnosis Code for COVID-19 Among US Hospitalizations

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Administrative claims may provide an understanding of the clinical and economic burden of novel coronavirus disease 2019 (COVID-19). However, their limited sensitivity in identifying conditions, such as sepsis,1 suggests the need to assess whether billing codes reliably capture COVID-19 discharges.

A new diagnosis code for COVID-19 (International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code U07.1) was introduced on April 1, 2020, to facilitate billing and case monitoring.2 For discharges prior to April 1, 2020, the Centers for Disease Control and Prevention advised coding for the clinical syndrome (eg, pneumonia) and “other coronavirus as the cause of diseases classified elsewhere” (ICD-10-CM code B97.29).3

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Article Information

Accepted for Publication: September 28, 2020.

Corresponding Author: Ning Rosenthal, MD, PhD, MPH, Premier Applied Sciences, Premier Healthcare Solutions Inc, 13034 Ballantyne Corporate Pl, Charlotte, NC 28277 (ning_rosenthal@premierinc.com).

Author Contributions: Ms Warner had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kadri, Gundrum, Cao, Rosenthal.

Acquisition, analysis, or interpretation of data: Kadri, Gundrum, Warner, Babiker, Klompas, Rosenthal.

Drafting of the manuscript: Kadri, Warner, Rosenthal.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gundrum, Warner, Cao, Rosenthal.

Obtained funding: Kadri, Rosenthal.

Administrative, technical, or material support: Warner, Rosenthal.

Supervision: Kadri, Rosenthal.

Conflict of Interest Disclosures: Mr Gundrum, Dr Cao, and Dr Rosenthal are employees and shareholders of Premier Healthcare Solutions Inc. Dr Klompas reported receiving grants from the Centers for Disease Control and Prevention and receiving grants and personal fees from UpToDate. No other disclosures were reported.

Funding/Support: This work was supported by Premier Healthcare Solutions Inc and the Intramural Research Program of the National Institutes of Health Clinical Center.

Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this study are those of the authors and do not necessarily represent the official position of the National Institutes of Health.

Additional Contributions: We thank John P. Dekker, MD, PhD, National Institute of Allergy and Infectious Diseases, for his insightful feedback on laboratory testing for SARS-CoV-2. Dr Dekker did not receive financial compensation for his contribution.

References
1.
Rhee  C , Dantes  R , Epstein  L ,  et al; CDC Prevention Epicenter Program.  Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.   JAMA. 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836PubMedGoogle ScholarCrossref
2.
Centers for Disease Control and Prevention. ICD-10-CM official coding and reporting guidelines: April 1, 2020 through September 30, 2020. Accessed October 9, 2020. https://www.cdc.gov/nchs/icd/icd10cm.htm
3.
Centers for Disease Control and Prevention. ICD-10-CM official coding guidelines—supplement coding encounters related to COVID-19 coronavirus outbreak (effective: February 20, 2020). Accessed October 9, 2020. https://www.cdc.gov/nchs/icd/icd10cm.htm
4.
World Health Organization. Emergency use ICD codes for COVID-19 disease outbreak. Accessed October 9, 2020. https://www.who.int/classifications/icd/covid19/en/
5.
Woloshin  S , Patel  N , Kesselheim  AS .  False negative tests for SARS-CoV-2 infection—challenges and implications.   N Engl J Med. 2020;383(6):e38. doi:10.1056/NEJMp2015897PubMedGoogle Scholar
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