Trends in ICD-10-CM-Coded Administrative Datasets for Injury Surveillance and Research.

OBJECTIVES: Accurate injury surveillance depends on data quality in administrative datasets created for billing and reimbursement. Significant effort has been devoted to testing the ability of candidate injury case definitions to identify injury cases accurately in these datasets. We used interviews with experienced coders, informed by a review of the current literature, to identify three clinical coding trends that may affect the consistency of surveillance data: "clinical documentation improvement or clinical documentation integrity" (CDI), coding by treating clinicians, and certain electronic health record features. METHODS: An extensive literature review informed interviews with coding experts to identify potential issues in coding practice. To determine whether physician coding was associated with information loss, we analyzed data from two hospitals serving the same geographic area. One hospital had used physician coding of emergency department data for the past decade; the other used professional coders. We compared the proportion of emergency department records missing external cause of injury codes and assessed the variation for statistical significance. RESULTS: CDI audits review patient records to ensure that billing information includes every relevant International Classification of Diseases, Tenth Revision, Clinical Modification code. This approach has increased payment rates awarded to Medicare Advantage plans because additional codes increase the patient acuity level and case mix index. The impact of CDI audits on injury data needs further investigation. The pilot analysis addressing information loss with physician coding found a higher level of external cause coding with clinician self-coding, possibly because of the coding software. Finally, widespread "copy and paste" in patient electronic health records has the potential to increase reported injuries. CONCLUSIONS: Injury surveillance relies on billing and reimbursement records. Financial motivations may interfere with the consistency of surveillance findings and mislead injury epidemiologists. Further investigation is essential to ensure the integrity of surveillance findings.

Practitioners Assess Achievements and Challenges of Nonfatal Injury Surveillance.

OBJECTIVE: Injury surveillance relies on data coded for administrative rather than epidemiological accuracy. The Centers for Disease Control and Prevention (CDC) established the 5-year Surveillance Quality Improvement (SQI) initiative to advance consensus and methodology for injury epidemiology reporting and analysis. Evaluation of the positive predictive value of the CDC's injury surveillance definitions based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding in designated injury categories comprised much of the SQI initiative's work. The goal of the current study is to identify achievements and challenges in SQI as articulated by experienced injury epidemiology practitioners who participated in the CDC-funded SQI initiative. DESIGN, SETTING, AND PARTICIPANTS: We conducted semistructured interviews with 12 representatives of state and federal public health agencies who had participated extensively in the SQI initiative. The interviews were transcribed and coded using NVivo qualitative analysis software. Initial coding of the data involved both in vivo coding (using the words of participants) and coding of a priori themes. MAIN OUTCOME MEASURES: Qualitative analysis identified 2 overarching themes, variability among states and observations on the science of injury surveillance. RESULTS: Within the 2 broad themes, the respondents provided valuable insights regarding access to medical records, case definition validation, unique contributions of medical record abstracting, variations in the practice of medical coding, and the potential for use of data from medical record reviews in other injury-related areas. CONCLUSIONS: The contributions of the SQI initiative have provided valuable insights into ICD-10-CM case definitions for national injury surveillance. Challenges remain with regard to data access and quality with ongoing reliance on administrative datasets for injury surveillance.