The impact of the ICD-9-CM to ICD-10-CM transition on the prevalence of birth defects among infant hospitalizations in the United States

Birth Defects Res. 2019 Nov 1;111(18):1365-1379. doi: 10.1002/bdr2.1578. Epub 2019 Aug 14.


Background: Many public health surveillance programs utilize hospital discharge data in their estimation of disease prevalence. These databases commonly use the International Classification of Diseases (ICD) coding scheme, which transitioned from the ICD-9 clinical modification (ICD-9-CM) to ICD-10-CM on October 1, 2015. This study examined this transition's impact on the prevalence of major birth defects among infant hospitalizations.

Methods: Using data from the Agency for Health Care Research and Quality-sponsored National Inpatient Sample, hospitalizations during the first year of life with a discharge date between January 1, 2012 and December 31, 2016 were used to estimate the monthly national hospital prevalence of 46 birth defects for the ICD-9-CM and ICD-10-CM timeframes separately. Survey-weighted Poisson regression was used to estimate 95% confidence intervals for each hospital prevalence. Interrupted time series framework and corresponding segmented regression was used to estimate the immediate change in monthly hospital prevalence following the ICD-9-CM to ICD-10-CM transition.

Results: Between 2012 and 2016, over 21 million inpatient hospitalizations occurred during the first year of life. Among the 46 defects studied, statistically significant decreases in the immediate hospital prevalence of five defects and significant increases in the immediate hospital prevalence of eight defects were observed after the ICD-10-CM transition.

Conclusions: Changes in prevalence were expected based on changes to ICD-10-CM. Observed changes for some conditions may result from variation in monthly hospital prevalence or initial unfamiliarity of coders with ICD-10-CM. These findings may help birth defects surveillance programs evaluate and interpret changes in their data related to the ICD-10-CM transition.

Keywords: International Classification of Diseases; National Inpatient Sample; birth defects; classification; coding; hospital discharge data; interrupted time series.

MeSH terms

  • Congenital Abnormalities / classification*
  • Databases, Factual
  • Female
  • Hospitalization
  • Hospitals
  • Humans
  • Infant
  • Infant, Newborn
  • International Classification of Diseases / standards*
  • International Classification of Diseases / trends*
  • Male
  • Population Surveillance
  • Prevalence
  • United States / epidemiology