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Using ICD-10-CM codes to detect illicit substance use: A comparison with retrospective self-report
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4 01 2021
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Source: Drug Alcohol Depend. 221:108537
[PDF-102.81 KB]
Details:
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Alternative Title:Drug Alcohol Depend
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Personal Author:
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Description:Background:
Understanding whether International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can be used to accurately detect substance use can inform their use in future surveillance and research efforts.
Methods:
Using 2015–2018 data from a retrospective cohort study of 602 safety-net patients prescribed opioids for chronic non-cancer pain, we calculated the sensitivity and specificity of using ICD-10-CM codes to detect illicit substance use compared to retrospective self-report by substance (methamphetamine, cocaine, opioids [heroin or non-prescribed opioid analgesics]), self-reported use frequency, and type of healthcare encounter.
Results:
Sensitivity of ICD-10-CM codes for detecting self-reported substance use was highest for methamphetamine (49.5 % [95 % confidence interval: 39.6–59.5 %]), followed by cocaine (44.4 % [35.8–53.2 %]) and opioids (36.3 % [28.8–44.2 %]); higher for participants who reported more frequent methamphetamine (intermittent use: 27.7 % [14.6–42.6 %]; ≥weekly use: 67.2 % [53.7–79.0 %]) and opioid use (intermittent use: 21.4 % [13.2–31.7 %]; ≥weekly use: 52.6 % [40.8–64.2 %]); highest for outpatient visits (methamphetamine: 43.8 % [34.1–53.8 %]; cocaine: 36.8 % [28.6− 45.6 %]; opioids: 33.1 % [25.9–41.0 %]) and lowest for emergency department visits (methamphetamine: 8.6 % [4.0− 15.6 %]; cocaine: 5.3 % [2.1− 10.5 %]; opioids: 6.3 % [3.0− 11.2 %]). Specificity was highest for methamphetamine (96.4 % [94.3–97.8 %]), followed by cocaine (94.0 % [91.5–96.0 %]) and opioids (85.0 % [81.3–88.2 %]).
Conclusions:
ICD-10-CM codes had high specificity and low sensitivity for detecting self-reported substance use but were substantially more sensitive in detecting frequent use. ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower- bound population measure of substance use or for capturing frequent use among certain patient populations.
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Source:
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Pubmed ID:33621806
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Pubmed Central ID:PMC11008535
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Funding:
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Volume:221
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