TY - JOUR AU - Deerin, Jessica AU - Chretien, Jean-Paul AU - Lewis, Paul PY - 2017/05/02 Y2 - 2024/03/28 TI - Evaluation of DoD Syndrome Mapping and Baseline for ICD-9-CM to ICD-10-CM Transition JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Novel algorithms, statistical or mathematical methods DO - 10.5210/ojphi.v9i1.7594 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7594 SP - AB - <div style="left: 90px; top: 320.758px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.08129);" data-canvas-width="63.778333333333336">Objective</div><div style="left: 105px; top: 335.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.996209);" data-canvas-width="378.34349999999995">The transition from ICD-9-CM to ICD-10-CM requires evaluation</div><div style="left: 90px; top: 352.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.977914);" data-canvas-width="392.97483333333327">of syndrome mappings to obtain a baseline for syndromic surveillance</div><div style="left: 90px; top: 369.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00373);" data-canvas-width="359.62083333333317">purposes. Two syndrome mappings are evaluated in this report.</div><div style="left: 90px; top: 400.758px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.11768);" data-canvas-width="82.63416666666666">Introduction</div><div style="left: 105px; top: 415.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01691);" data-canvas-width="381.3935833333333">The Department of Defense conducts syndromic surveillance</div><div style="left: 90px; top: 432.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.06458);" data-canvas-width="397.81416666666655">of health encounter visits of Military Health System (MHS)</div><div style="left: 90px; top: 449.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.956497);" data-canvas-width="394.5869999999999">beneficiaries. Providers within the MHS assign up to 10 diagnosis</div><div style="left: 90px; top: 465.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.988234);" data-canvas-width="393.1193333333334">codes to each health encounter visit. The diagnosis codes are grouped</div><div style="left: 90px; top: 482.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.965944);" data-canvas-width="394.6847500000002">into syndrome and sub-syndrome categories. On October 1, 2015,</div><div style="left: 90px; top: 499.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01502);" data-canvas-width="390.32566666666634">the Health and Human Services-mandated transition from ICD-</div><div style="left: 90px; top: 515.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00206);" data-canvas-width="393.59108333333324">9-CM to ICD-10-CM required evaluation of the syndrome mappings</div><div style="left: 90px; top: 532.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02682);" data-canvas-width="394.40283333333326">to establish a baseline of syndrome rates within the DoD. The DoD</div><div style="left: 90px; top: 549.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.031);" data-canvas-width="394.4255">data within the BioSense system currently utilizes DoD ESSENCE</div><div style="left: 90px; top: 565.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.99287);" data-canvas-width="392.7793333333332">syndrome mappings. The Master Mapping Reference Table (MMRT)</div><div style="left: 90px; top: 582.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03356);" data-canvas-width="394.5459166666667">was developed by the CDC to translate diagnostic codes across the</div><div style="left: 90px; top: 599.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.98646);" data-canvas-width="395.70191666666653">ICD-9-CM and ICD-10-CM encoding systems to prepare for the</div><div style="left: 90px; top: 615.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.99395);" data-canvas-width="393.0739999999999">transition. The DoD ESSENCE and MMRT syndrome definitions are</div><div style="left: 90px; top: 632.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00075);" data-canvas-width="235.29416666666665">presented in this analysis for comparison.</div><div style="left: 90px; top: 664.091px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.07287);" data-canvas-width="58.23916666666666">Methods</div><div style="left: 105px; top: 679.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0097);" data-canvas-width="381.2802499999999">DoD data was pulled from the BioSense Platform through a</div><div style="left: 90px; top: 695.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.968477);" data-canvas-width="394.91283333333325">RStudio server on October 11, 2016, querying data from October</div><div style="left: 90px; top: 712.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.961128);" data-canvas-width="395.1196666666667">1, 2014 to September 30, 2016. This time period provides twelve</div><div style="left: 90px; top: 729.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02641);" data-canvas-width="394.22574999999995">months of ICD-9-CM data and twelve months of ICD-10-CM data.</div><div style="left: 90px; top: 745.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00888);" data-canvas-width="393.8333333333333">The ICD codes were binned to both DoD ESSENCE syndromes and</div><div style="left: 90px; top: 762.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03948);" data-canvas-width="394.7782499999998">MMRT macro syndromes for comparison. Although a patient visit</div><div style="left: 90px; top: 779.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.04959);" data-canvas-width="394.59266666666593">may contain up to 10 ICD codes, only the first four were included</div><div style="left: 90px; top: 795.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03492);" data-canvas-width="394.2200833333333">for this analysis. Providers are trained to prioritize diagnosis codes</div><div style="left: 90px; top: 812.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00851);" data-canvas-width="393.7908333333332">by position. Only 2.2% of visits had greater than 4 diagnostic codes.</div><div style="left: 90px; top: 829.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.04099);" data-canvas-width="394.5175833333333">Each ICD code in a visit is binned to an applicable syndrome. The</div><div style="left: 90px; top: 845.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.0415);" data-canvas-width="394.4850000000003">total number of visits includes visits that binned and did not bin to</div><div style="left: 90px; top: 862.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.956394);" data-canvas-width="394.54449999999974">a syndrome. Multiple syndromes may be assigned to one patient’s</div><div style="left: 90px; top: 879.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.9924);" data-canvas-width="393.1391666666667">health encounter visit if multiple ICD codes are binned. Additionally,</div><div style="left: 90px; top: 895.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.981449);" data-canvas-width="393.08674999999994">more than one code per visit may bin to the same syndrome; however,</div><div style="left: 90px; top: 912.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03237);" data-canvas-width="394.5189999999995">only unique syndromes are counted in the total syndrome rate. The</div><div style="left: 90px; top: 929.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03649);" data-canvas-width="394.4878333333334">total syndrome rate was calculated by total unique syndrome visits</div><div style="left: 90px; top: 945.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01175);" data-canvas-width="393.9409999999999">as the numerator and total number of visits during the ICD-9-CM or</div><div style="left: 90px; top: 962.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.998485);" data-canvas-width="393.41966666666667">ICD-10-CM time period as the denominator. The rates per 1000 total</div><div style="left: 90px; top: 979.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00095);" data-canvas-width="125.5025">visits were calculated.</div><div style="left: 90px; top: 1010.76px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="51.17">Results</div><div style="left: 105px; top: 1025.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02785);" data-canvas-width="381.9673333333332">Among the DoD ESSENCE syndromes, the ICD-9-CM rate</div><div style="left: 90px; top: 1042.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.981049);" data-canvas-width="395.9186666666666">for ILI was 36.3 per 1,000 compared to the ICD-10-CM rate of</div><div style="left: 90px; top: 1059.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.952973);" data-canvas-width="395.0233333333332">38.6 per 1,000. The ICD-9-CM rate for neurological was 18.1 per</div><div style="left: 90px; top: 1075.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00078);" data-canvas-width="322.23499999999996">1,000 compared to the ICD-10-CM rate of 0.2 per 1,000.</div><div style="left: 105px; top: 1092.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.95908);" data-canvas-width="379.79558333333335">Among the MMRT syndromes, the ICD-9-CM rate for ILI was</div><div style="left: 90px; top: 1109.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.03104);" data-canvas-width="394.4425000000002">16.7 per 1,000 compared to the ICD-10-CM rate of 38.4 per 1,000.</div><div style="left: 90px; top: 1125.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.970713);" data-canvas-width="392.68583333333333">The ICD-9-CM rate for mental disorders was 73.8 per 1,000 compared</div><div style="left: 90px; top: 1142.38px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00064);" data-canvas-width="234.50083333333336">to the ICD-10-CM rate of 73.2 per 1,000.</div><div style="left: 90px; top: 1174.09px; font-size: 14.1667px; font-family: sans-serif; transform: scaleX(1.10336);" data-canvas-width="85.01416666666667">Conclusions</div><div style="left: 105px; top: 1189.04px; font-size: 14.1667px; font-family: serif; transform: scaleX(0.96864);" data-canvas-width="380.0944999999999">This analysis provides baseline rates of MMRT syndromes and</div><div style="left: 90px; top: 1205.71px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.01912);" data-canvas-width="394.3149999999998">sub-syndromes for syndromic surveillance during the ICD-9-CM to</div><div style="left: 510px; top: 319.043px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.02612);" data-canvas-width="394.5416666666668">ICD-10-CM transition. These data will serve for future comparison</div><div style="left: 510px; top: 335.709px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00563);" data-canvas-width="393.72141666666676">and tracking of syndrome-specific trends for military-relevant health</div><div style="left: 510px; top: 352.376px; font-size: 14.1667px; font-family: serif; transform: scaleX(1.00105);" data-canvas-width="41.309999999999995">threats.</div> ER -