Assessing the uniformity of uveitis clinical concepts and associated ICD-10 codes across healthcare systems sharing the same electronic medical records system

Abstract

Purpose : To determine the degree of uniformity in mapping of uveitis clinical concepts to International Classification of Diseases, Tenth Revision (ICD-10) code across healthcare systems using the same electronic health record (EHR) system.

Methods : Researchers from five different healthcare systems (University of Washington, Harvard University, Stanford University, Yale University, University of California San Francisco), each of which employ the Epic EHR, queried 54 uveitis related diagnostic terms and recorded associated ICD-10 codes. The main outcome measure was the degree of uniformity for uveitis ICD-10 code associations.

Results : Fifty-four uveitis related diagnostic terms were queried within the Epic EHR at five different healthcare systems. There was perfect agreement among all five centers for 52 out of 54 diagnostic terms. The proportion of uveitis diagnoses with identical ICD-10 mapping on pair-wise comparison between centers was greater than 96% for all comparisons (Table). Two diagnostic terms were observed to have differences in ICD-10 coding: (1) juvenile idiopathic arthritis associated chronic uveitis and (2) intermediate uveitis. Intermediate uveitis was associated with H20.1x (ICD-10 description: ‘chronic iridocyclitis’) or H20.9 (ICD-10 description: ‘unspecified iridocyclitis’) in three centers while being associated with H30.2x (ICD-10 description: ‘posterior cyclitis’) at the two remaining centers. The discrepancies appear to be related to a recent update in diagnostic mapping in the Epic EHR. Further, considerable overlap was observed for multiple diagnostic terms with the same code, creating anatomic, etiologic, and infectious non-specificity in identifying diagnosis by ICD-10 code. Fifteen diagnostic terms had no ICD-10 association at any of the centers.

Conclusions : ICD-10 mapping to uveitis diagnostic terminology appears to be highly uniform at different centers with the Epic EHR. However, temporal changes in diagnosis mapping to ICD-10 code and lack of one-to-one mapping of diagnosis to ICD-10 code add additional sources of complexity to interpretation of big data studies in uveitis.

This is a 2021 ARVO Annual Meeting abstract.

 

There is a high degree of uniformity in mapping of uveitis diagnostic concepts to ICD-10 code between centers. ICD-10 mapping was identical between UW and Stanford, as well as between Yale and UCSF.