Utilization of Medical Codes for Hypotension in Shock Patients: A Retrospective Analysis

• Published in: Journal of multidisciplinary healthcare Vol. 14; pp. 861 - 867
• Main Authors: Hunley, Charles, Murphy, Shannon M E, Bershad, Michael, Yapici, Halit O
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Analysis; Blood pressure; clinical coding; Clinical outcomes; data accuracy; Demographics; Documentation; Electronic health records; Health care policy; Health services; Hypotension; international classification of diseases; Medical coding; Medical records; Medical research; Medicare; Medicine, Experimental; Mortality; Original Research; Patients; Sepsis; Septic shock; Trends; United States > US; International Classification of Diseases; blood pressure; clinical coding; data accuracy
• ISSN: 1178-2390; 1178-2390
• DOI: 10.2147/JMDH.S305985

To evaluate the utilization of hypotension diagnosis codes by shock type and year in known hypotensive patients. 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. 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). Hypotension codes are remarkably underutilized in known hypotensive patients. Patients, providers, and researchers are likely to benefit from improved hypotension coding practices.