ArticleScandinavian journal of primary health care2009
Three- and four-digit ICD-10 is not a reliable classification system in primary care.
Article in Scandinavian journal of primary health care, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed.
- Prevalence and direct costs of vestibular disease in France - matched case-control study results from the 2022 and 2023 french health data system.Cost effectiveness and resource allocation : C/E · 2026Article
- Leveraging Ensemble Machine Learning Models for the Detection of Primary Myelofibrosis in Electronic Health Records.Cancers · 2026Article
- Large language models as medical code selectors: a benchmark using the International Classification of Primary Care.JAMIA open · 2026Article
- Pharmacy cost groups for the German morbidity-based risk compensation scheme.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Trends in Miscarriages and Stillbirths in Panama From 2002 to 2024.Obstetrics and gynecology international · 2026Article
- Alcohol-associated liver disease is associated with less adverse outcomes compared to nonalcohol-associated liver disease in patients with COVID-19.Alcohol, clinical & experimental research · 2025Observational
- Frequency distribution of health disorders in primary care-its consistency and meaning for diagnostics and nomenclature.Wiener medizinische Wochenschrift (1946) · 2025Article
- Developing and testing a framework for coding general practitioners' free-text diagnoses in electronic medical records - a reliability study for generating training data in natural language processing.BMC primary care · 2024Article
- Saxon Epidemiological Study in General Practice-6 (SESAM-6): protocol of a cross-sectional study.BMJ open · 2024Article
- Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2023Article
- Exposure to anticholinergic and sedative medication is associated with impaired functioning in older people with vertigo, dizziness and balance disorders-Results from the longitudinal multicenter study MobilE-TRA.Frontiers in pharmacology · 2023Article
- Predicting Short-Term Mortality in Older Patients Discharged from Acute Hospitalizations Lasting Less Than 24 Hours.Clinical epidemiology · 2023Article
- Last year of life of adults with congenital heart diseases: causes of death and patterns of care.European heart journal · 2022Article
- Article
- Simplified data science approach to extract social and behavioural determinants: a retrospective chart review.BMJ open · 2022Article
- Combining the GP's assessment and the PHQ-9 questionnaire leads to more reliable and clinically relevant diagnoses in primary care.PloS one · 2022Article
- Identifying subgroups and risk among frequent emergency department users in British Columbia.Journal of the American College of Emergency Physicians open · 2021Article
- Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding.BMC public health · 2018Article
- Coding of medically unexplained symptoms and somatoform disorders by general practitioners - an exploratory focus group study.BMC family practice · 2018Article
- [Health disorders and their prevalence in two primary care practices from the perspective of different coding].Wiener medizinische Wochenschrift (1946) · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe International Classification of Diseases 10th revision (ICD-10) is a standard international diagnostic classification for medical diagnoses. Reliable diagnostic coding is of high medical and epidemiological importance. Coding diagnoses with ICD-10 is the basis of reimbursement in some healthcare systems.
designThe ICD-10 coding of each case was performed by two raters to investigate the inter-rater agreement. The degree of agreement was assessed using Cohen's kappa. Kappa was divided into two groups: Kappa > or = 0.61 meaning high or satisfactory and kappa < or = 0.6 (incl. < or = 0.000 and 0.000*) meaning low or unsatisfactory. SUBJECTS: Cross-sectional data were collected from 8877 randomly selected patients. The 209 participating general practitioners used a standardized data collection form. The first of the reasons for encounter was taken into account on new and chronic managed problems.
resultsKappa values were satisfactory on the chapter level with on average 0.685 (chronic managed problems) and 0.675 (new managed problems). Kappa was unsatisfactory when the three-digit level was used (0.428) and lower for terminal codes (four-digit level) at 0.199 on average (chronic managed problems). For new managed problems the kappa values were at 0.384 (three-digit level) and 0.166 (four-digit level) on average.
conclusionThe ICD-10 is reliable for coding managed problems on the chapter level. Further refinement of ICD-10 with three- and four-digit codes leads to significant coding uncertainties. There is no reliable coding scheme that meets the demands of general practice. The use of coded data for healthcare reimbursement requires a simplification of ICD-10 to provide a realistic picture of morbidity.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.