• Kevin C Heslin, Pamela L Owens, Zeynal Karaca, Marguerite L Barrett, Brian J Moore, and Anne Elixhauser.
• *Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD †ML Barrett Inc., Del Mar, CA ‡IBM Watson Health, Ann Arbor, MI.
• Med Care. 2017 Nov 1; 55 (11): 918-923.

BackgroundTrend analyses of opioid-related inpatient stays depend on the availability of comparable data over time. In October 2015, the US transitioned diagnosis coding from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM, increasing from ∼14,000 to 68,000 codes. This study examines how trend analyses of inpatient stays involving opioid diagnoses were affected by the transition to ICD-10-CM.SubjectsData are from Healthcare Cost and Utilization Project State Inpatient Databases for 14 states in 2015-2016, representing 26% of acute care inpatient discharges in the US.Study DesignWe examined changes in the number of opioid-related stays before, during, and after the transition to ICD-10-CM using quarterly ICD-9-CM data from 2015 and quarterly ICD-10-CM data from the fourth quarter of 2015 and the first 3 quarters of 2016.ResultsOverall, stays involving any opioid-related diagnosis increased by 14.1% during the ICD transition-which was preceded by a much lower 5.0% average quarterly increase before the transition and followed by a 3.5% average increase after the transition. In stratified analysis, stays involving adverse effects of opioids in therapeutic use showed the largest increase (63.2%) during the transition, whereas stays involving abuse and poisoning diagnoses decreased by 21.1% and 12.4%, respectively.ConclusionsThe sharp increase in opioid-related stays overall during the transition to ICD-10-CM may indicate that the new classification system is capturing stays that were missed by ICD-9-CM data. Estimates of stays involving other diagnoses may also be affected, and analysts should assess potential discontinuities in trends across the ICD transition.

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