Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database

Health Serv Res. 2008 Aug;43(4):1424-41. doi: 10.1111/j.1475-6773.2007.00822.x.


Objective: The goal of this study was to assess the validity of the International Classification of Disease, 10th Version (ICD-10) administrative hospital discharge data and to determine whether there were improvements in the validity of coding for clinical conditions compared with ICD-9 Clinical Modification (ICD-9-CM) data.

Methods: We reviewed 4,008 randomly selected charts for patients admitted from January 1 to June 30, 2003 at four teaching hospitals in Alberta, Canada to determine the presence or absence of 32 clinical conditions and to assess the agreement between ICD-10 data and chart data. We then re-coded the same charts using ICD-9-CM and determined the agreement between the ICD-9-CM data and chart data for recording those same conditions. The accuracy of ICD-10 data relative to chart data was compared with the accuracy of ICD-9-CM data relative to chart data.

Results: Sensitivity values ranged from 9.3 to 83.1 percent for ICD-9-CM and from 12.7 to 80.8 percent for ICD-10 data. Positive predictive values ranged from 23.1 to 100 percent for ICD-9-CM and from 32.0 to 100 percent for ICD-10 data. Specificity and negative predictive values were consistently high for both ICD-9-CM and ICD-10 databases. Of the 32 conditions assessed, ICD-10 data had significantly higher sensitivity for one condition and lower sensitivity for seven conditions relative to ICD-9-CM data. The two databases had similar sensitivity values for the remaining 24 conditions.

Conclusions: The validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions was generally similar though validity differed between coding versions for some conditions. The implementation of ICD-10 coding has not significantly improved the quality of administrative data relative to ICD-9-CM. Future assessments like this one are needed because the validity of ICD-10 data may get better as coders gain experience with the new coding system.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Alberta / epidemiology
  • Current Procedural Terminology
  • Databases, Factual
  • Diagnostic Tests, Routine / classification
  • Diagnostic Tests, Routine / statistics & numerical data
  • Forms and Records Control / statistics & numerical data*
  • Humans
  • International Classification of Diseases / classification*
  • International Classification of Diseases / statistics & numerical data*
  • Medical Records / classification*
  • Medical Records / statistics & numerical data*
  • Medical Records Department, Hospital / classification*
  • Medical Records Department, Hospital / statistics & numerical data*
  • Patient Discharge / statistics & numerical data
  • Quality Indicators, Health Care
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity