Early impact of the ICD-10-CM transition on selected health outcomes in 13 electronic health care databases in the United States

Pharmacoepidemiol Drug Saf. 2018 Aug;27(8):839-847. doi: 10.1002/pds.4563. Epub 2018 Jun 26.


Purpose: To describe the consistency in the frequency of 5 health outcomes across the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) eras in the US.

Methods: We examined the incidence of 3 acute conditions (acute myocardial infarction [AMI], angioedema, ischemic stroke) and the prevalence of 2 chronic conditions (diabetes, hypertension) during the final 5 years of the ICD-9-CM era (January 2010-September 2015) and the first 15 months of the ICD-10-CM era (October 2015-December 2016) in 13 electronic health care databases in the Sentinel System. For each health outcome reviewed during the ICD-10-CM era, we evaluated 4 definitions, including published algorithms derived from other countries, as well as simple-forward, simple-backward, and forward-backward mapping using the General Equivalence Mappings. For acute conditions, we also compared the incidence between April to December 2014 and April to December 2016.

Results: The analyses included data from approximately 172 million health plan members. While the incidence or prevalence of AMI and hypertension performed similarly across the 2 eras, the other 3 outcomes did not demonstrate consistent trends for some or all the ICD-10-CM definitions assessed.

Conclusions: When using data from both the ICD-9-CM and ICD-10-CM eras, or when using results from ICD-10-CM data to compare to results from ICD-9-CM data, researchers should test multiple ICD-10-CM outcome definitions as part of sensitivity analysis. Ongoing assessment of the impact of ICD-10-CM transition on identification of health outcomes in US electronic health care databases should occur as more data accrue.

Keywords: ICD-10-CM; acute myocardial infarction; angioedema; diabetes; hypertension; ischemic stroke; pharmacoepidemiology; sentinel.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease / epidemiology
  • Adverse Drug Reaction Reporting Systems / statistics & numerical data*
  • Angioedema / chemically induced
  • Angioedema / diagnosis
  • Angioedema / epidemiology
  • Brain Infarction / chemically induced
  • Brain Infarction / diagnosis
  • Brain Infarction / epidemiology
  • Chronic Disease / epidemiology
  • Clinical Coding / classification*
  • Clinical Coding / statistics & numerical data
  • Diabetes Mellitus / chemically induced
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / diagnosis
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / etiology
  • Humans
  • Hypertension / chemically induced
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Incidence
  • International Classification of Diseases
  • Myocardial Infarction / chemically induced
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology
  • Outcome Assessment, Health Care / methods*
  • Outcome Assessment, Health Care / statistics & numerical data
  • Prevalence
  • Stroke / chemically induced
  • Stroke / diagnosis
  • Stroke / epidemiology
  • United States / epidemiology