{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:54:08Z","timestamp":1790873648646,"version":"4.1.0"},"reference-count":112,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Cardiovascular-kidney-metabolic (CKM) syndrome is a multisystem construct describing the intertwined progression of cardiometabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease. The American Heart Association (AHA) proposed CKM stages (0\u20104) for risk stratification and prevention. However, CKM lacks a single\n                      <jats:italic>ICD-10-CM<\/jats:italic>\n                      (\n                      <jats:italic>International Classification of Diseases, Tenth Revision, Clinical Modification<\/jats:italic>\n                      ) code, which hinders standardized stage identification in electronic health records and claims data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study aimed to develop an AHA-aligned\n                      <jats:italic>ICD-10-CM<\/jats:italic>\n                      coding framework as an implementation template that operationalizes CKM stages 0\u20104 for reproducible cohort identification and stage-based analyses in real-world data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We mapped AHA CKM stages (0\u20104) to\n                      <jats:italic>ICD-10-CM<\/jats:italic>\n                      diagnosis code sets using Fiscal Year 2026 conventions, code-set engineering best practices, and clinician review. To improve reproducibility, we defined a hierarchical staging algorithm, co-occurrence rules, and recommended lookback and encounter-confirmation thresholds. Stage 3 includes guidance for electronic health record\u2013enhanced ascertainment and claims-only proxies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We provide stage-specific\n                      <jats:italic>ICD-10-CM<\/jats:italic>\n                      code sets for CKM stages 0\u20104. Stage 1 captures excess or dysfunctional adiposity or prediabetes. Stage 2 captures established metabolic disease and earlier-stage CKD. Stage 3 captures subclinical cardiovascular injury or very high-risk CKD. Stage 4 captures overt clinical cardiovascular disease events, with or without kidney failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This implementation framework enables transparent, reproducible CKM staging in real-world datasets and supports stage-based epidemiologic and health-system applications. Empirical validation and local implementation testing are needed before clinical deployment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/91827","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T08:50:08Z","timestamp":1776156608000},"page":"e91827-e91827","source":"Crossref","is-referenced-by-count":3,"title":["Cardiovascular-Kidney-Metabolic Syndrome: Development of an ICD-10-CM Coding 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