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J Am Acad Orthop Surg. 2019 Apr 8. doi: 10.5435/JAAOS-D-17-00874. [Epub ahead of print]

Reliability of International Classification of Disease-9 Versus International Classification of Disease-10 Coding for Proximal Femur Fractures at a Level 1 Trauma Center.

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From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Dr. Schneble), the Department of Orthopaedic Surgery (Dr. Natoli), the Department of Radiology (Dr. Schonlau), the Department of Surgery (Dr. Reed), Indiana University School of Medicine, Indianapolis, IN, and the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC (Dr. Kempton).



The Centers for Medicare & Medicaid services proposed that transitioning from the 9th to the 10th revision of the International Classification of Disease (ICD) would provide better data for research. This study sought to determine the reliability of ICD-10 compared with ICD-9 for proximal femur fractures.


Available imaging studies from 196 consecutively treated proximal femur fractures were retrospectively reviewed and assigned ICD codes by three physicians. Intercoder reliability (ICR) was calculated. Collectively, the physicians agreed on what should be the correct codes for each fracture, and this was compared with coding found in the medical and billing records.


No significant difference was observed in ICR for both ICD-9 and ICD-10 exact coding, which were both unreliable. Less specific coding improved ICR. ICD-9 general coding was better than ICD-10. Electronic medical record coding was unreliable. Billing codes were also unreliable, yet ICD-10 was better than ICD-9.


ICD-9 and ICD-10 lack reliability in coding proximal femur fractures. ICD-10 results in data that are no more reliable than those found with ICD-9.


Level I diagnostic.


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