Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity

Stephan Y Chiu,1 Jeremy W Shaw,1 Tiffany Q Luong,2 Donald S Fong,1–3 Bobeck S Modjtahedi1,3 1Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 2Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA; 3Depar...

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Autores principales:	Chiu SY, Shaw JW, Luong TQ, Fong DS, Modjtahedi BS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Hydroxychloroquine plaquenil coding ICD retinopathy accuracy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/ea9c2b294cb14e368f1bee239ac52bc6
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spelling	oai:doaj.org-article:ea9c2b294cb14e368f1bee239ac52bc62021-12-02T03:13:26ZCoding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity1177-5483https://doaj.org/article/ea9c2b294cb14e368f1bee239ac52bc62018-11-01T00:00:00Zhttps://www.dovepress.com/coding-patterns-used-by-ophthalmologists-for-hydroxychloroquine-retina-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Stephan Y Chiu,1 Jeremy W Shaw,1 Tiffany Q Luong,2 Donald S Fong,1–3 Bobeck S Modjtahedi1,3 1Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 2Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA; 3Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA Purpose: The aim of this study was to characterize International Classification of Diseases (ICD-9) coding patterns used by ophthalmologists in clinical practice for hydroxychloroquine (HCQ) retinal toxicity.Design: This is a retrospective cohort study.Subjects: Patients enrolled in the Kaiser Permanente Southern California health plan who were dispensed HCQ between 2001 and 2014 were included in this study.Methods: Patients’ medical records were electronically searched for the following ICD-9 codes that can be used to characterize retinopathy or maculopathy: toxic maculopathy, non-exudative age-related macular degeneration (AMD), drusen (degenerative), and/or (other) background retinopathy. The charts of patients with these codes were then manually reviewed to determine which of these patients had been diagnosed by their ophthalmologists with HCQ retinopathy.Main outcome measures: ICD-9 codes used to indicate HCQ toxicity.Results: A total of 23,362 patients were dispensed HCQ between 2001 and 2014. Of whom, 678 (2.9%) patients received at least one of the aforementioned ICD-9 codes with 53 having confirmed HCQ toxicity on chart review. Forty-three patients who were taking HCQ received a diagnosis code for toxic maculopathy, and of whom, 35 (81.4%) had HCQ toxicity. Of the patients with confirmed HCQ toxicity, 32.1% received a code other than toxic maculopathy to connote the presence of disease.Conclusion: Although toxic maculopathy is the most commonly used ICD-9 code to identify patients with HCQ toxicity, a significant number of patients with toxicity received other codes in their medical records. Additionally, almost one-fifth of the patients who were coded as having toxic maculopathy were ultimately not diagnosed with HCQ toxicity. This study underscores the often imprecise nature of ICD coding, especially in conditions without a specific associated code. The limitations of using coding information should also be considered when conducting research that utilizes electronic databases. Future investigations should determine how to improve database searches and methods to create more uniform coding standards among ophthalmologists, especially for rare conditions such as HCQ toxicity. Keywords: hydroxychloroquine, billing, database, plaquenil, coding, International Classification of Diseases, retinopathy, accuracyChiu SYShaw JWLuong TQFong DSModjtahedi BSDove Medical PressarticleHydroxychloroquineplaquenilcodingICDretinopathyaccuracyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 2261-2265 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hydroxychloroquine plaquenil coding ICD retinopathy accuracy Ophthalmology RE1-994
spellingShingle	Hydroxychloroquine plaquenil coding ICD retinopathy accuracy Ophthalmology RE1-994 Chiu SY Shaw JW Luong TQ Fong DS Modjtahedi BS Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
description	Stephan Y Chiu,1 Jeremy W Shaw,1 Tiffany Q Luong,2 Donald S Fong,1–3 Bobeck S Modjtahedi1,3 1Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 2Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA; 3Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA Purpose: The aim of this study was to characterize International Classification of Diseases (ICD-9) coding patterns used by ophthalmologists in clinical practice for hydroxychloroquine (HCQ) retinal toxicity.Design: This is a retrospective cohort study.Subjects: Patients enrolled in the Kaiser Permanente Southern California health plan who were dispensed HCQ between 2001 and 2014 were included in this study.Methods: Patients’ medical records were electronically searched for the following ICD-9 codes that can be used to characterize retinopathy or maculopathy: toxic maculopathy, non-exudative age-related macular degeneration (AMD), drusen (degenerative), and/or (other) background retinopathy. The charts of patients with these codes were then manually reviewed to determine which of these patients had been diagnosed by their ophthalmologists with HCQ retinopathy.Main outcome measures: ICD-9 codes used to indicate HCQ toxicity.Results: A total of 23,362 patients were dispensed HCQ between 2001 and 2014. Of whom, 678 (2.9%) patients received at least one of the aforementioned ICD-9 codes with 53 having confirmed HCQ toxicity on chart review. Forty-three patients who were taking HCQ received a diagnosis code for toxic maculopathy, and of whom, 35 (81.4%) had HCQ toxicity. Of the patients with confirmed HCQ toxicity, 32.1% received a code other than toxic maculopathy to connote the presence of disease.Conclusion: Although toxic maculopathy is the most commonly used ICD-9 code to identify patients with HCQ toxicity, a significant number of patients with toxicity received other codes in their medical records. Additionally, almost one-fifth of the patients who were coded as having toxic maculopathy were ultimately not diagnosed with HCQ toxicity. This study underscores the often imprecise nature of ICD coding, especially in conditions without a specific associated code. The limitations of using coding information should also be considered when conducting research that utilizes electronic databases. Future investigations should determine how to improve database searches and methods to create more uniform coding standards among ophthalmologists, especially for rare conditions such as HCQ toxicity. Keywords: hydroxychloroquine, billing, database, plaquenil, coding, International Classification of Diseases, retinopathy, accuracy
format	article
author	Chiu SY Shaw JW Luong TQ Fong DS Modjtahedi BS
author_facet	Chiu SY Shaw JW Luong TQ Fong DS Modjtahedi BS
author_sort	Chiu SY
title	Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
title_short	Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
title_full	Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
title_fullStr	Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
title_full_unstemmed	Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
title_sort	coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/ea9c2b294cb14e368f1bee239ac52bc6
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_version_	1718401894474317824

Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity

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