Journal of Multidisciplinary Healthcare (Apr 2021)
Utilization of Medical Codes for Hypotension in Shock Patients: A Retrospective Analysis
Abstract
Charles Hunley,1 Shannon ME Murphy,2 Michael Bershad,2 Halit O Yapici3 1Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL, USA; 2Edwards Lifesciences, Irvine, CA, USA; 3Boston Strategic Partners, Inc., Boston, MA, USACorrespondence: Charles HunleyDepartment of Critical Care Medicine, Orlando Regional Medical Center, 86 West Underwood Street, Suite 102, Orlando, FL, 32806, USATel +1 407 927 7955Fax +1 321 843 3569Email [email protected]: To evaluate the utilization of hypotension diagnosis codes by shock type and year in known hypotensive patients.Patients and Methods: Retrospective analysis of the Medicare fee-for-service claims database. Patients with a shock diagnosis code between 2011 and 2017 were identified using the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM). Based on specific ICD codes corresponding to each shock type, patients were classified into four mutually exclusive cohorts: cardiogenic shock, hypovolemic shock, septic shock, and other/unspecified shock. Annual proportion and counts of cases with at least one hypotension ICD code for each shock cohort were generated to produce 7-year medical code utilization trends. A Cochran-Armitage test for trend was performed to evaluate the statistical significance.Results: A total of 2,200,275 shock patients were analyzed, 13.3% (n=292,192) of which received a hypotension code. Hypovolemic shock cases were the most likely to receive a hypotension code (18.02%, n=46,544), while septic shock cases had the lowest rate (11.48%, n=158,348). The proportion of patients with hypotension codes for other cohorts were 18.0% (n=46,544) for hypovolemic shock and 16.9% (n=32,024) for other/unspecified shock. The presence of hypotension codes decreased by 0.9% between 2011 and 2014, but significantly increased from 10.6% in 2014 to 17.9% in 2017 (p < 0.0001, Z=− 105.05).Conclusion: Hypotension codes are remarkably underutilized in known hypotensive patients. Patients, providers, and researchers are likely to benefit from improved hypotension coding practices.Keywords: blood pressure, clinical coding, data accuracy, International Classification of Diseases
