Understanding the Efficacy of ICD-10 System in Evaluating Care for Peripheral Arterial Disease Patients

In the healthcare landscape, it’s critical to have accurate and reliable systems to track and categorize health conditions. However, according to a study by Birmpili, Atkins, Li, Johal, Waton, Williams, Pherwani, and Cromwell, the accuracy of a widely used system – the International Classification of Diseases 10th Revision (ICD-10) – raises some questions. The team sought to determine whether the ICD-10 system effectively supports evaluating care for patients with peripheral arterial disease (PAD) who underwent revascularisation in England.

Researchers looked at patient records between January 2017 and December 2019, collected in the National Vascular Registry (NVR), and linked to the Hospital Episode Statistics (HES) administrative database, which commonly supports studies evaluating hospital care in England. If a patient’s NVR record didn’t match up with HES data due to reasons such as lack of consent or differing admission and procedure dates, they were excluded from the study.

The study was extensive, including 20,603 patients and 24,621 admissions. The researchers compared multiple parameters, including gender, age, comorbidities, mode of admission, and procedure type and side.

So, what did they find?

The good news is that there was excellent agreement between the NVR and HES when it came to gender and age, with a Kappa statistic (a measure of agreement) of 0.98 for both. The mode of admission also showed high concordance (Kappa = 0.80), as did the type and side of the procedure (Kappa = 0.92 and 0.87, respectively).

However, when it came to diagnosing different stages of PAD, the results were less promising. The study found substantial agreement for chronic ischaemia with tissue loss (Kappa = 0.63), but it dropped considerably for chronic ischaemia without tissue loss (Kappa = 0.32) and acute limb ischaemia (Kappa = 0.15). Similarly, the accuracy for comorbidities was mixed – excellent for diabetes (Kappa = 0.82), moderate for chronic lung disease, chronic kidney disease, and ischaemic heart disease (Kappa = 0.56, 0.56, and 0.45, respectively), and fair for chronic heart failure (Kappa = 0.35).

So, where does this leave us?

The takeaway from this study is that the current ICD-10 codes used in the HES system may not accurately differentiate between stages of PAD. This could potentially introduce misclassification bias in studies that use HES to examine patterns of care and outcomes for patients with PAD.

To address this, researchers suggest adopting an extended ICD-10 system or switching to the ICD-11 version released by the World Health Organisation in 2022.

Ultimately, it’s about improving care for PAD patients and ensuring accurate data for future studies. Only with accurate tracking and categorization can we continue to make strides in our understanding and treatment of this disease.

This reminds us of the importance of continuing to evaluate and improve the tools we use to monitor and analyze health data. After all, good data leads to good healthcare.


Panagiota Birmpili, Eleanor Atkins, Qiuju Li, Amundeep S. Johal, Sam Waton, Robin Williams, Arun D. Pherwani, David A. Cromwell, Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: a retrospective cohort study using national administrative and clinical databases, eClinicalMedicine, Volume 55, 2023, 101738, ISSN 2589-5370, https://doi.org/10.1016/j.eclinm.2022.101738

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