New Fluency, Cognition Diagnosis Codes

Abstract This article explains the development and use of ICD-9-CM diagnosis codes, CPT procedure codes, and HCPCS supply/device codes. Examples of appropriate coding combinations, and Coding rules adopted by most third party payers are given. Additionally, references for complete code lists on the Web and a list of voice-related CPT code edits are included. The reader is given adequate information to report an evaluation or treatment session with accurate diagnosis, procedure, and supply/device codes. Speech-language pathologists can accurately code services when given adequate resources and rules and are encouraged to insert relevant codes in the medical record rather than depend on billing personnel to accurately provide this information. Consultation is available from the Division 3 Reimbursement Committee members and from [email protected] .

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Increasing the Density of Laboratory Measures for Machine Learning Applications

Journal of Clinical Medicine ◽

10.3390/jcm10010103 ◽

2020 ◽

Vol 10 (1) ◽

pp. 103

Author(s):

Vida Abedi ◽

Jiang Li ◽

Manu K. Shivakumar ◽

Venkatesh Avula ◽

Durgesh P. Chaudhary ◽

...

Keyword(s):

Hybrid Approach ◽

Secondary Diagnosis ◽

Healthcare Applications ◽

Modeling Tools ◽

Clostridioides Difficile ◽

Laboratory Values ◽

Diagnosis Codes ◽

Problem Lists ◽

Downstream Analysis ◽

Laboratory Measures

Background. The imputation of missingness is a key step in Electronic Health Records (EHR) mining, as it can significantly affect the conclusions derived from the downstream analysis in translational medicine. The missingness of laboratory values in EHR is not at random, yet imputation techniques tend to disregard this key distinction. Consequently, the development of an adaptive imputation strategy designed specifically for EHR is an important step in improving the data imbalance and enhancing the predictive power of modeling tools for healthcare applications. Method. We analyzed the laboratory measures derived from Geisinger’s EHR on patients in three distinct cohorts—patients tested for Clostridioides difficile (Cdiff) infection, patients with a diagnosis of inflammatory bowel disease (IBD), and patients with a diagnosis of hip or knee osteoarthritis (OA). We extracted Logical Observation Identifiers Names and Codes (LOINC) from which we excluded those with 75% or more missingness. The comorbidities, primary or secondary diagnosis, as well as active problem lists, were also extracted. The adaptive imputation strategy was designed based on a hybrid approach. The comorbidity patterns of patients were transformed into latent patterns and then clustered. Imputation was performed on a cluster of patients for each cohort independently to show the generalizability of the method. The results were compared with imputation applied to the complete dataset without incorporating the information from comorbidity patterns. Results. We analyzed a total of 67,445 patients (11,230 IBD patients, 10,000 OA patients, and 46,215 patients tested for C. difficile infection). We extracted 495 LOINC and 11,230 diagnosis codes for the IBD cohort, 8160 diagnosis codes for the Cdiff cohort, and 2042 diagnosis codes for the OA cohort based on the primary/secondary diagnosis and active problem list in the EHR. Overall, the most improvement from this strategy was observed when the laboratory measures had a higher level of missingness. The best root mean square error (RMSE) difference for each dataset was recorded as −35.5 for the Cdiff, −8.3 for the IBD, and −11.3 for the OA dataset. Conclusions. An adaptive imputation strategy designed specifically for EHR that uses complementary information from the clinical profile of the patient can be used to improve the imputation of missing laboratory values, especially when laboratory codes with high levels of missingness are included in the analysis.

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143. Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.188 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S82-S82

Author(s):

Zahra Kassamali Escobar ◽

Todd Bouchard ◽

Jose Mari Lansang ◽

Scott Thomassen ◽

Joanne Huang ◽

...

Keyword(s):

Primary Care ◽

Viral Infections ◽

Respiratory Infections ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Specific Rate ◽

Inclusion Criteria ◽

Diagnosis Codes ◽

Control And Prevention ◽

Viral Respiratory Infections

Abstract Background Between 15–50% of patients seen in ambulatory settings are prescribed an antibiotic. At least one third of this usage is considered unnecessary. In 2019, our institution implemented the MITIGATE Toolkit, endorsed by the Centers for Disease Control and Prevention to reduce inappropriate antibiotic prescribing for viral respiratory infections in emergency and urgent care settings. In February 2020 we identified our first hospitalized patient with SARS-CoV(2). In March, efforts to limit person-to-person contact led to shelter in place orders and substantial reorganization of our healthcare system. During this time we continued to track rates of unnecessary antibiotic prescribing. Methods This was a single center observational study. Electronic medical record data were accessed to determine antibiotic prescribing and diagnosis codes. We provided monthly individual feedback to urgent care prescribers, (Sep 2019-Mar 2020), primary care, and ED providers (Jan 2020 – Mar 2020) notifying them of their specific rate of unnecessary antibiotic prescribing and labeling them as a top performer or not a top performer compared to their peers. The primary outcome was rate of inappropriate antibiotic prescribing. Results Pre toolkit intervention, 14,398 patient visits met MITIGATE inclusion criteria and 12% received an antibiotic unnecessarily in Jan-April 2019. Post-toolkit intervention, 12,328 patient visits met inclusion criteria and 7% received an antibiotic unnecessarily in Jan-April 2020. In April 2020, patient visits dropped to 10–50% of what they were in March 2020 and April 2019. During this time the unnecessary antibiotic prescribing rate doubled in urgent care to 7.8% from 3.6% the previous month and stayed stable in primary care and the ED at 3.2% and 11.8% respectively in April compared to 4.6% and 10.4% in the previous month. Conclusion Rates of inappropriate antibiotic prescribing were reduced nearly in half from 2019 to 2020 across 3 ambulatory care settings. The increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning. Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV(2) pandemic. Disclosures All Authors: No reported disclosures

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Babesiosis Occurrence among the U.S. Medicare Beneficiaries Ages 65 and Older, During 2006-2017: Overall, and by State and County of Residence

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa608 ◽

2020 ◽

Author(s):

Mikhail Menis ◽

Barbee I Whitaker ◽

Michael Wernecke ◽

Yixin Jiao ◽

Anne Eder ◽

...

Keyword(s):

New York ◽

Rhode Island ◽

Parasitic Infection ◽

Medicare Beneficiaries ◽

Study Objective ◽

Diagnosis Codes ◽

Real World Evidence ◽

At Risk Populations ◽

Human Babesiosis ◽

The U.S

Abstract Background Human babesiosis is a mild-to-severe parasitic infection that poses health concerns especially in older and other at-risk populations. The study objective was to assess babesiosis occurrence among the U.S. Medicare beneficiaries, ages 65 and older, during 2006-2017. Methods Our retrospective claims-based study utilized Medicare databases. Babesiosis cases were identified using recorded diagnosis codes. The study estimated rates (per 100,000 beneficiary-years) overall, by year, diagnosis month, demographics, state and county of residence. Results Nationwide, 19,469 beneficiaries had babesiosis recorded, a rate of 6 per 100,000 person-years, ranging from 4 in 2006 to 9 in 2017 (p<0.05). The highest babesiosis rates were in: Massachusetts (62), Rhode Island (61), Connecticut (51), New York (30), and New Jersey (19). The highest rates by county were in: Nantucket, MA (1,089); Dukes, MA (236); Barnstable, MA (213); and Dutchess, NY (205). Increasing rates, from 2006 through 2017 (p<0.05), were identified in multiple states, including states previously considered non-endemic. New Hampshire, Maine, Vermont, Pennsylvania, and Delaware saw rates increase by several times. Conclusion Our 12-year study shows substantially increasing babesiosis diagnosis trends, with highest rates in well-established endemic states. It also suggests expansion of babesiosis infections in other states and highlights the utility of real-world evidence.

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10-year trend analysis of atrioventricular node ablation in patient with atrial fibrillation: 2005–2014 United State hospitalization

European Heart Journal ◽

10.1093/ehjci/ehaa946.0549 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Wu ◽

B Narasimhan ◽

A.N Shah ◽

Y.Y Zheng ◽

K Bhatia ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrioventricular Node ◽

Health Care Research ◽

Progressive Increase ◽

Pharmacological Therapy ◽

Af Ablation ◽

Diagnosis Codes ◽

Increasing Trend ◽

Quality Guideline ◽

Pacemaker Insertion

Abstract Introduction Atrial fibrillation (AF) ablation and Atrioventricular Node (AVN) ablation are both important non-pharmacological therapy of AF. In spite of increased availability of AF ablation data, that of AVN ablation per se is limited. Method AF ablation was identified using ICD-9 procedure code with principle diagnosis of AF from United States National Inpatient Sample database 2005–2014. From procedure and diagnosis codes of pacemaker insertion followed by ablation, the cohort who underwent AVN ablation was identified. Patients hospitalization with any diagnosis of other type of arrythmia or epicardial ablation were excluded. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results Total AF ablation was noted to increase from 2005- 2011, and declined steadily from 2011–2014. In contrast, the number of AVN ablations increased from 4505 cases to 5175 (Figure 1). AVN ablation were mainly performed in elderly patient (mean age 72), and increasingly in patient with higher Charlson Commobidity index (0.9 to 1.7)and higher CHA2DS2-VASc score (2.8 to 3.7) (Table 1). An increasing trend in procedure complications but no significant change in mortalitywere observed with AVN ablation. Progressive increase in the length of stay and the hospitalization cost were also observed over the years with AVN ablation. Conclusion AVN ablation is being performed at a steady volume, and increasingly in patients with multiple comorbidities. This trend although was not associated with increased mortality, it was associated with increased hospital complications. Funding Acknowledgement Type of funding source: None

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Factors Associated With Retained Foreign Bodies Following Major Operations

The American Surgeon ◽

10.1177/00031348211024969 ◽

2021 ◽

pp. 000313482110249

Author(s):

Arjun Verma ◽

Zachary Tran ◽

Joseph Hadaya ◽

Catherine G. Williamson ◽

Rhea Rahimtoola ◽

...

Keyword(s):

Pulmonary Infection ◽

Foreign Bodies ◽

Laparoscopic Approach ◽

Mitigation Strategies ◽

Financial Outcomes ◽

Factors Associated ◽

Diagnosis Codes ◽

Hospitalization Costs ◽

High Risk Populations ◽

Nationally Representative

Background Retained surgical foreign bodies (RFB) are associated with inferior clinical and financial outcomes. The present work examined a nationally representative sample of all major operations to identify factors associated with RFB. Study Design The 2005-2017 National Inpatient Sample was used to identify adults undergoing cardiac, neurosurgical, orthopedic, genitourinary, gastrointestinal, vascular, and thoracic operations. International Classifications of Diseases 9th-10th Revisions diagnosis codes were used to identify instances of RFB. Results Of an estimated 71,445,042 hospitalizations, .02% had a diagnosis of RFB, with decreasing incidence from .03 to .02% over the study period (NPtrend < .001). Relative to vascular operations, gastrointestinal (adjusted odds ratio [AOR] 2.12), thoracic (AOR 1.80), and multi-cavity (AOR 2.17) were associated with greater odds of RFB. Laparoscopic approach (AOR .33) and trauma-associated admission (AOR .52, all P < .001) were associated with reduced odds of RFB. Despite similar mortality, RFB was associated with increased odds of pulmonary infection (AOR 1.62), sepsis (AOR 1.26), and wound infection (AOR 5.15), as well as a 2.3-day increment in length of stay and $7700 in hospitalization costs (all P < .001). Conclusion The development of novel mitigation strategies may reduce the incidence of RFB in high-risk populations, such as those undergoing gastrointestinal, thoracic, and multi-cavity operations.

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Derivation and external validation of risk stratification models for severe maternal morbidity using prenatal encounter diagnosis codes

Journal of Perinatology ◽

10.1038/s41372-021-01072-z ◽

2021 ◽

Author(s):

Mark A. Clapp ◽

Thomas H. McCoy Jr ◽

Kaitlyn E. James ◽

Anjali J. Kaimal ◽

Roy H. Perlis

Keyword(s):

Risk Stratification ◽

Maternal Morbidity ◽

External Validation ◽

Severe Maternal Morbidity ◽

Diagnosis Codes

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OP0271 REAL-WORLD CLINICAL BURDEN AND GLUCOCORTICOID USE IN PATIENTS WITH POLYMYALGIA RHEUMATICA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4285 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 169.1-169

Author(s):

R. Punekar ◽

P. Lafontaine ◽

J. H. Stone

Keyword(s):

Cardiovascular Disease ◽

Health Plan ◽

Polymyalgia Rheumatica ◽

Data Availability ◽

Categorical Variables ◽

Continuous Variables ◽

Rank Tests ◽

Medical Claim ◽

Diagnosis Codes

Background:Polymyalgia rheumatica (PMR) is a chronic inflammatory condition characterized by aching and morning stiffness in the neck, shoulders and pelvic girdle. It is a common inflammatory rheumatic disease in patients age >50 years, particularly women. While giant cell arteritis (GCA) is present in 9–21% of PMR cases, many PMR patients have symptoms independent of GCA. Current treatment options are limited to long-term glucocorticoid (GC), however, with risks of GC-related complications, including cardiovascular disease, osteoporosis, and diabetes mellitus.Objectives:To compare GC use and subsequent GC-related complications in patients with PMR vs a general population (GnP) cohort.Methods:This retrospective, observational cohort study was based on Optum’s de-identified Clinformatics®Data Mart Database (study period 01Jan2006-30June2018). The PMR cohort included patients with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart with PMR related diagnosis codes (ICD-9: 725.xx or ICD-10: M35.3x) between 01Jan2006–30June2017 (patient identification period) during which first occurrence of a PMR-related medical claim was set as the index date (ID). Patients with ≥1 medical claim related to rheumatoid arthritis (RA) or GCA during the study period were excluded. The GnP cohort included patients without any RA, GCA or PMR diagnosis codes during the study period, with their ID set as 12 months from the start of continuous health plan enrollment. Patients in both cohorts were required to be age ≥50 years (on ID) with continuous health plan enrollment ≥12 months pre- and post-ID. Cohorts were 1:1 propensity score matched. GC use and incidence of GC-related complications were assessed from GC initiation, starting from the baseline period (12-months pre-ID) through to the end of GC use during the post-index period (i.e. the end of data availability, end of the study period or death [whichever occurred first]). Mean, standard deviation (SD) and median values for continuous variables, and frequency (n and %) for categorical variables were compared between the matched cohorts. Wilcoxon sum rank tests andt-tests on continuous variables and Chi-square tests or Fisher’s exact tests on categorical variables between matched cohorts were conducted. Duration of GC use was analyzed using the Kaplan-Meier method and compared between matched cohorts using log-rank tests.Results:In each of the PMR and GnP cohorts, 16,865 patients were included. In both matched cohorts, median age was 76 years, median Elixhauser comorbidity index score was 2.0, and the majority (~65%) were women. The median follow-up duration was 45 months and 51 months in the PMR and GnP cohorts, respectively. A higher proportion of patients in the PMR cohort than the matched GnP cohort (90.4% vs 62.8%;p<0.001) used GC. The mean (SD) duration of GC therapy was significantly longer in the PMR cohort than in the matched GnP cohort (242.1 [±317.2] days vs 35.5 [±124.6] days;p<0.001). Although patients in the PMR cohort had a lower average daily dose of GC (prednisone equivalent) vs the GnP cohort (mean [SD] mg 16.3 [± 21.9] vs 27.8 [±24.5], respectively [p<0.0001)], the cumulative GC dose was significantly higher in the PMR cohort than the GnP cohort (2125.4 [±3689.5] mg vs 476.6 [±1450.9] mg;p<0.001). This indicates PMR patients used chronic low dose GC while the GnP patients utilized higher dose GC burst therapy less frequently. The number of incident complications associated with GC use were significantly greater in the PMR cohort, and included hypertension, diabetes, skin toxicity, infections, neuropsychiatric effects, endocrine abnormalities, renal dysfunction/ failure, ocular effects, and cardiovascular disease (p<0.05).Conclusion:The overall GC burden in patients with PMR is high. With a higher incidence of GC-related comorbidities among PMR patients, early onset of these complications may be a significant contributor to long-term healthcare costs in these patients.Acknowledgments:This study was funded by Sanofi, Inc. Medical writing, under the direction of authors, was provided by Gauri Saal, MA Economics, Prime, Knutsford, UK, and funded by Sanofi.Disclosure of Interests:Rajeshwari Punekar Shareholder of: Sanofi, Employee of: Sanofi, Patrick LaFontaine Shareholder of: Sanofi, Employee of: Sanofi, John H. Stone Grant/research support from: Roche, Consultant of: Roche

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