Altered patient demography and increased complexity of ICD coding in uveitis over 10 years

Abstract

Purpose : Uveitis is an inflammatory ocular disease and important cause of visual impairment and blindness. The purpose of this study is to delineate the demography and pattern of clinical coding between 2008 and 2018.

Methods : The Stanford Research Repository (STARR) Tools was used to identify 5,441 patients with International Classification of Diseases (Ninth and Tenth Editions) (ICD) codes for infectious and non-infectious uveitis in one academic institution (Table 1) in patients 18 years or older from 2008 to 2018. Patient demography (age, gender, race, ethnicity), pattern of ICD coding, and types of uveitis was analyzed using custom R scripts.

Results : Of 5,441 unique patients with infectious/non-infectious uveitis, analysis of patient demography revealed that age at first visit significantly increased between 2008 to 2018 (p<0.001), with no change in gender, race, ethnicity (p>0.1) (Table 1). Analysis of uveitis ICD codes revealed gradual increase in the number of infectious/non-infectious uveitis codes used and marked increase in the complexity of coding. In 2008, there were only 3 ICD codes used to designate infectious/non-infectious uveitis, which increased by 2014. By 2018, there were 9 different ICD codes. The most striking changes in ICD coding was in the frequency of ICD codes 135, 362.18, and 115.92. The most common ICD9 code in the data set was 135 (sarcoidosis); the usage of this ICD code significantly increased over the decade (p<0.01). In contrast, ICD9 codes 362.18 (retinal vasculitis) and 115.92 (histoplasmosis retinitis) were not commonly used at the beginning of the decade, but later in the decade, their use significantly increased (p<0.001). Despite its introduction in 2016, ICD10 codes were not used frequently. There was only one ICD10 code (B39.9) significantly used (p<0.05).

Conclusions : Analysis of patient demography and ICD coding of uveitis between 2008-2018 of uveitis in one academic institution revealed significant increase in age at first visit but not gender, race, and ethnicity and a dramatic increase in the usage of uveitis ICD codes and the complexity of uveitis coding. Despite its introduction in 2016, ICD10 codes are still relatively unused. Given the specificity of ICD10 coding to include laterality, etiology, anatomic parts involved, and severity, improved education and utilization of ICD10 coding can help elucidate the pattern and complexity of uveitis.

This is a 2021 ARVO Annual Meeting abstract.