July 2018
Volume 59, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2018
Coding patterns among ophthalmologists for hydroxychloroquine retinal toxicity
Author Affiliations & Notes
  • Stephan Chiu
    Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
    Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, United States
  • Tiffany Luong
    Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, United States
  • Michael Batech
    Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, United States
  • Jeremy Shaw
    Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California, United States
  • Donald S Fong
    Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California, United States
    Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California, United States
  • Bobeck Modjtahedi
    Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California, United States
    Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California, United States
  • Footnotes
    Commercial Relationships   Stephan Chiu, None; Tiffany Luong, None; Michael Batech, None; Jeremy Shaw, None; Donald Fong, None; Bobeck Modjtahedi, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1842. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Stephan Chiu, Tiffany Luong, Michael Batech, Jeremy Shaw, Donald S Fong, Bobeck Modjtahedi; Coding patterns among ophthalmologists for hydroxychloroquine retinal toxicity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1842.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : Clinical studies increasingly rely on data extraction from electronic medical record’s diagnosis and billing codes; however, coding patterns are not always uniform. This study characterizes International Classification of Disease-9 (ICD-9) coding patterns for hydroxychloroquine (HCQ) retinal toxicity.

Methods : Patients dispensed hydroxychloroquine between 2001-2014 and enrolled in the Kaiser Permanente Southern California plan were examined in this study. Patients’ medical charts were electronically searched for the following ICD-9 codes which connote retinopathy: toxic maculopathy, non-exudative age-related macular degeneration (AMD), drusen (degenerative), and/or (other) background retinopathy. The charts of patients with these codes were then manually reviewed to determine which codes had been used by their ophthalmologists in patients diagnosed with HCQ toxicity.

Results : 23,362 patients were dispensed HCQ between 2001-2014, of which 678 (2.9%) patients received at least one of the above ICD-9 codes. Forty-three patients received a diagnosis code for toxic maculopathy and of these 35 (81.4%) had confirmed HCQ toxicity. There was a total of 52 patients who were diagnosed with HCQ toxicity by their ophthalmologists; however, 32.7% of these patients received a code other than toxic maculopathy in their chart to connote the presence of their HCQ toxicity.

Conclusions : Although toxic maculopathy is the most commonly used ICD-9 code to identify patients with HCQ toxicity, a significant number of patients with toxic maculopathy received other codes in their medical records from their ophthalmologists at the time of toxicity diagnosis. Additionally, almost a fifth of patients who were coded as having toxic maculopathy at some point in their care were ultimately not diagnosed with HCQ toxicity. This study underscores the often imprecise nature of ICD coding which is an important consideration in data extraction for studies. Manual data review is necessary to determine the precise incidence of HCQ toxicity. Unfortunately, ICD-10 does not provide improved specificity for HCQ toxicity. Efforts should be made to create more uniform coding standards among ophthalmologists, especially for rare conditions, and develop more specific future ICD classifications.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×