Validating Publicly Available Crosswalks for Translating ICD-9 to ICD-10 Diagnosis Codes for Cardiovascular Outcomes Research

Circ Cardiovasc Qual Outcomes. 2018 Oct;11(10):e004782. doi: 10.1161/CIRCOUTCOMES.118.004782.


Background On October 1, 2015, the Center for Medicare and Medicaid Services transitioned from the International Classification of Diseases, Ninth Revision ( ICD-9) to the ICD, Tenth Revision ( ICD-10) compendium of codes for diagnosis and billing in health care, but translation between the two is often inexact. Here we describe a validated crosswalk to translate ICD-9 codes into ICD-10 codes, with a focus on complications after carotid revascularization and endovascular aortic aneurysm repair. Methods and Results We devised an 8-step process to derive and validate ICD-10 codes from existing ICD-9 codes. We used publicly available sources, including the General Equivalence Mapping database, to translate ICD-9 codes used in prior work to ICD-10 codes. We defined ICD-10 codes as validated if they were concordant with the initial ICD-9 codes after manual comparison by two physicians. Our primary validation measure was the percent of valid ICD-10 codes out of the total ICD-10 codes obtained during translation. We began with 126 ICD-9 diagnosis codes used for complication identification after carotid revascularization procedures, and 97 ICD-9 codes for complications after endovascular aortic aneurysm procedures. Translation generated 143 ICD-10 codes for carotid revascularization, a 14% increase from the initial 126 codes. Manual comparison demonstrated 98% concordance, with 99% agreement between the reviewers. Similarly, we identified 108 ICD-10 codes for endovascular aortic aneurysm repair, an 11% increase from the initial 97 ICD-9 codes. We again noted excellent concordance and agreement (98% and 100%, respectively). Manual review identified 4 ICD-10 codes incorrectly translated from ICD-9 codes for carotid revascularization, and 3 codes incorrectly translated for endovascular aortic aneurysm repair. Conclusions Algorithms to crosswalk lists of ICD-9 codes to ICD-10 codes can leverage electronic resources to minimize the burden of code translation. However, manual review for code validation may be necessary, with collaboration across institutions for researchers to share their efforts.

Keywords: International Classification of Diseases; aneurysm; diagnosis; health services research; heart failure; stroke.

Publication types

  • Validation Study

MeSH terms

  • Algorithms*
  • Angioplasty / adverse effects*
  • Angioplasty / instrumentation
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / surgery*
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / therapy*
  • Data Mining / methods*
  • Databases, Factual
  • Endarterectomy, Carotid / adverse effects*
  • Endovascular Procedures / adverse effects*
  • Health Services Research / methods*
  • Humans
  • International Classification of Diseases*
  • Outcome Assessment, Health Care / methods*
  • Postoperative Complications / classification
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Stents
  • Treatment Outcome