Direct Versus Indirect Query Performance of ICD-9/-10 Coding to Identify Anaphylaxis

Christina E Eldredge; Etienne Pracht; Joel Gallagher; Athanasios Tsalatsanis

doi:10.1016/j.jaip.2022.12.034

Direct Versus Indirect Query Performance of ICD-9/-10 Coding to Identify Anaphylaxis

J Allergy Clin Immunol Pract. 2023 Apr;11(4):1190-1197.e2. doi: 10.1016/j.jaip.2022.12.034. Epub 2023 Jan 6.

Authors

Christina E Eldredge¹, Etienne Pracht², Joel Gallagher³, Athanasios Tsalatsanis⁴

Affiliations

¹ School of Information, University of South Florida, Tampa, Fla. Electronic address: celdredge2@usf.edu.
² College of Public Health, University of South Florida, Tampa, Fla.
³ Cone Health, University of North Carolina-Chapel Hill, Chapel Hill, NC.
⁴ Morsani College of Medicine, University of South Florida Health, Tampa, Fla.

PMID: 36621609
DOI: 10.1016/j.jaip.2022.12.034

Abstract

Background: Anaphylaxis is an often under =diagnosed, severe allergic event for which epidemiological data are sporadic. Researchers have leveraged administrative and claims data algorithms to study large databases of anaphylactic events; however, little longitudinal data analysis is available after transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

Objective: Study longitudinal trends in anaphylaxis incidence using direct and indirect query methods.

Methods: Emergency department (ED) and inpatient data were analyzed from a large state health care administration database from 2011 to 2020. Incidence was calculated using direct queries of anaphylaxis ICD-9-CM and ICD-10-CM codes and indirect queries using a symptom-based ICD-9-CM algorithm and forward mapped ICD-10-CM version to identify undiagnosed anaphylaxis episodes and to assess algorithm performance at the population level.

Results: An average of 2.4 million inpatient and 7.5 million ED observations/y were analyzed. Using the direct query method, annual ED anaphylaxis cases increased steadily from 1,454 (2011) to 4,029 (2019) then declined to 3,341 in 2020 during the coronavirus disease 2019 (COVID-19) pandemic. In contrast, inpatient cases remained relatively steady, with a slight decline after 2015 during the ICD version transition, until a significant drop occurred in 2020. Using the indirect queries, anaphylaxis cases increased markedly after the ICD transition year, especially involving drug-related anaphylaxis.

Conclusions: Nontypical drug associations with anaphylaxis episodes using the ICD-10-CM version of the algorithm suggest poor performance with drug-related codes. Further, the increased granularity of ICD-10-CM identified potential limitations of a previously validated symptom-based ICD-9-CM algorithm used to detect undiagnosed cases.

Keywords: Anaphylactic shock; Anaphylaxis; Data analysis; ICD-10; ICD-9.

MeSH terms

Algorithms
Anaphylaxis* / diagnosis
Anaphylaxis* / epidemiology
COVID-19* / epidemiology
Emergency Service, Hospital
Humans
International Classification of Diseases