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Revalidation of the Hypoglycemia Risk Stratification Tool Using ICD-10 Codes

A. Karter,E. M. Warton,H. Moffet,J. Ralston,E. Huang,Donald R. Miller,K. Lipska

Published 2019 in Diabetes Care

ABSTRACT

We previously developed and validated a hypoglycemia risk stratification tool (1) and made available the computer source code for implementation (online-only supplemental eTable 2 [1]). This tool classifies 12-month risk of hypoglycemia-related utilization (HRU) of emergency department (ED) or in-patient services among type 2 diabetes (T2D) patients as high (>5%), intermediate (1–5%), or low (<1%). Since its publication, health care delivery systems in the U.S. (including Kaiser Permanente and Mayo Clinic) have adopted this tool to identify higher-risk patients for targeted population management interventions designed to reduce hypoglycemia risk. Among the six inputs required to calculate HRU risk (prior HRU, insulin use, sulfonylurea use, any ED visits, chronic kidney disease stage, and age), only prior HRU relied on diagnostic coding and was based on an algorithm (2) comprising International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Since 1 October 2015, the Centers for Medicare & Medicaid Services has required use of the 10th revision (ICD-10-CM), necessitating an updated HRU case identification algorithm that includes ICD-10-CM codes for hypoglycemia. We identified ICD-10-CM codes for hypoglycemia to complement the existing ICD-9-CM–based algorithm (any of the following: 251.0, 251.1, 251.2, 962.3, or 250.8, without concurrent 259.8, 272.7, 681.XX, 682.XX, 686.9X, 707.1–707.9, 709.3, 730.0–730.2, or 731.8). The ICD-10-CM codes for hypoglycemia (any of the …

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