AHRQ also derived and evaluated the model fit of a summary Elixhauser score, based on weighting the individual comorbidities, to predict in-hospital mortality and 30-day all-cause re-admissions in hospitalized adults. The set of Elixhauser comorbidity indicators was developed in 1998 but has undergone modifications, including the addition of weighted scores and expanded comorbidity codes. Compared with the original score, it has similar performance in predicting readmission in a population of United States commercially insured individuals.Summary comorbidity scores, such as the Charlson comorbidity index and the Elixhauser comorbidity index, can both describe comorbidity burden in observational studies and be used for prognosis. We propose an ICD-10-CM version of the combined comorbidity score that includes codes identified by ICD-10-CA and GEMs. The algorithm based on ICD-10-CA codes had the most similar discrimination for readmission to the ICD-9-CM version (c, 0.646 95% CI, 0.639-0.653), but combining all identified ICD-10-CM codes had the highest c-statistic (c, 0.651 95% CI, 0.644-0.657). We used logistic regression models to predict 30-day hospital readmission for the original score in the ICD-9-CM cohort and for each ICD-10-CM algorithm in the ICD-10-CM cohort.ĭistributions of each version of the score were similar. The ICD-9-CM cohort comprised patients who had a hospitalization between Januand March 1, 2015. The ICD-10-CM cohort comprised patients who had a hospitalization between Januand March 1, 2016.
We used claims data from the Clinfomatics Data Mart to identify 2 cohorts. The objective of this study is to examine different coding algorithms for the ICD-10-CM combined comorbidity score and compare their performance to the original ICD-9-CM score.įour ICD-10-CM coding algorithms were defined: 2 using General Equivalence Mappings (GEMs), one based on ICD-10-CA (Canadian modification) codes for Charlson and Elixhauser measures, and one including codes from all 3 algorithms. In October 2015, the United States adopted the 10th revision (ICD-10-CM). The combined comorbidity score, which merges the Charlson and Elixhauser comorbidity indices, uses the ninth revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM).
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