{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:15:24Z","timestamp":1792505724807,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,8]]},"abstract":"\n Background and Purpose\u2014<\/jats:title>\n \n International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification<\/jats:italic>\n (\n ICD-9-CM<\/jats:italic>\n and\n ICD-10-CM<\/jats:italic>\n ) codes are often used for disease surveillance. We examined changes in concordance between\n ICD-CM<\/jats:italic>\n codes and clinical diagnoses before and after the transition to\n ICD-10-CM<\/jats:italic>\n in the United States (October 1, 2015), and determined if there were systematic variations in concordance by patient and hospital characteristics.\n <\/jats:p>\n <\/jats:sec>\n \n Methods\u2014<\/jats:title>\n \n We included Paul Coverdell National Acute Stroke Program patient discharges from 2014 to 2017. Concordance between\n ICD-CM<\/jats:italic>\n codes and the clinical diagnosis documented by the physician (assumed as accurate) was calculated for each diagnosis category: ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage.\n <\/jats:p>\n <\/jats:sec>\n \n Results\u2014<\/jats:title>\n \n In total, 314\u2009857 patient records were included in the analysis (n=280 hospitals), 55.9% of which were obtained after the transition to\n ICD-10-CM<\/jats:italic>\n . While concordance was generally high, a small, and temporary decline occurred from the last calendar quarter of\n ICD-9-CM<\/jats:italic>\n (average unadjusted concordance =92.8%) to the first quarter of\n ICD-10-CM<\/jats:italic>\n use (91.0%). Concordance differed by diagnosis category and was generally highest for ischemic stroke. In the analysis of\n ICD-10-CM<\/jats:italic>\n records, disagreements often occurred between ischemic stroke and transient ischemic attack records and between subarachnoid and intracerebral hemorrhage records. Compared with the smallest hospitals (\u2264200 beds), larger hospitals had significantly higher odds of concordance (ischemic stroke adjusted odds ratio for \u2265400 beds, 1.7; 95% CI, 1.5\u20131.9).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions\u2014<\/jats:title>\n \n This study identified a small and transient decline in concordance between\n ICD-CM<\/jats:italic>\n codes and stroke clinical diagnoses during the coding transition, indicating no substantial impact on the overall identification of stroke patients. Researchers and policymakers should remain aware of potential changes in\n ICD-CM<\/jats:italic>\n code accuracy over time, which may affect disease surveillance. Systematic variations in the accuracy of codes by hospital and patient characteristics have implications for quality-of-care studies and hospital comparative assessments.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/strokeaha.118.024092","type":"journal-article","created":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T05:00:25Z","timestamp":1560834025000},"page":"1959-1967","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Trends and Factors Associated With Concordance Between\n International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification<\/i>\n Codes and Stroke Clinical Diagnoses"],"prefix":"10.1161","volume":"50","author":[{"given":"Tiffany E.","family":"Chang","sequence":"first","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"},{"name":"IHRC, Inc, Atlanta, GA (T.E.C., X.Y.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Tong","sequence":"additional","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary G.","family":"George","sequence":"additional","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallyann M.","family":"Coleman King","sequence":"additional","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"},{"name":"United States Public Health Service (S.M.C.K., J.L.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Yin","sequence":"additional","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"},{"name":"IHRC, Inc, Atlanta, GA (T.E.C., X.Y.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services, Lansing (S.O., G.I.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services, Lansing (S.O., G.I.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Liskay","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center, Cleveland, OH (A.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Paul Coverdell National Acute Stroke Program team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Wiltz","sequence":"additional","affiliation":[{"name":"From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., X.T., M.G.G., S.M.C.K., X.Y., J.L.W.)"},{"name":"United States Public Health Service (S.M.C.K., J.L.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000558"},{"key":"e_1_3_3_3_2","unstructured":"International Classification of Diseases (ICD-10-CM\/PCS) transition- background. https:\/\/www.cdc.gov\/nchs\/icd\/icd10cm_pcs_background.htm. 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Paul Coverdell National Acute Stroke Registry surveillance - four states, 2005\u20132007. MMWR Surveill Summ. 2009;58:1\u201323.","journal-title":"MMWR Surveill Summ"},{"key":"e_1_3_3_14_2","unstructured":"Specifications Manual for Joint Commission National Quality Measures (v2016A). Appendix A. ICD-10 code tables. https:\/\/manual.jointcommission.org\/releases\/TJC2016A\/AppendixATJC.html#Table_Number_8.1:_Ischemic_Stroke. Accessed August 1 2018."},{"key":"e_1_3_3_15_2","unstructured":"Centers for Medicare & Medicaid Services. 2017 ICD-10-CM and GEMS. https:\/\/www.cms.gov\/Medicare\/Coding\/ICD10\/2017-ICD-10-CM-and-GEMs.html. 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Accessed August 1 2018."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.47.suppl_1.wp378"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135834"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2312"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.118.024092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T12:39:34Z","timestamp":1762864774000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.118.024092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1161\/STROKEAHA.118.024092"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.118.024092","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]},"assertion":[{"value":"2018-11-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-30","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}