Chronic coronary artery disease: aspects of recording and coding in clinical practice (results of a survey of physicians)

Abstract

Aim. To study the opinion of doctors about the applicability, frequency and criteria for practical use of codes of the International Classification of Diseases, 10th revision (ICD-10) from the group of chronic coronary artery disease (CAD) — I25.0, I25.1, I25.8, I25.9.Material and methods. This cross-sectional study was conducted in the period from February 27, 2024 to March 11, 2024 on a continuous sample of medical workers who agreed to participate in an anonymous survey as respondents. The questionnaire consisted of an introductory, personal and main part, which consisted of 19 questions devoted to various aspects of chronic CAD coding at the doctor’s appointment and during preparing medical death certificate. This article presents the results of a survey of cardiologists (group 1) and internists/general practitioners/family physicians (group 2). The χ2 test was used to compare two groups. The Friedman test was used to test the hypothesis that the physicians' opinion about the use of different chronic CAD codes was random. The Kendall test was used to assess the agreement between physicians. Calculations were carried out using Microsoft Office Excel 2021 and SPSS-26.0.Results. A total of 883 doctors from 47 constituent entities of the Russian Federation took part in the survey. Half of the respondents believed that there are differences between the codes I25.0, I25.1, I25.8, I25.9 and that they are necessary for statistical recording. Although cardiologists (59,2%) were less likely than internists/general practitioners/family doctors (65,9%) to believe that one or more of the 4 codes analyzed could be used only on the basis of risk factors, differences did not reach significance (p=0,1). The need to confirm chronic CAD using paraclinical research methods varied from 57,3% for code I25.9 to 83,1% for code I25.1. In case of death of a patient from chronic CAD, almost a third of respondents do not see the differences between the 4 specified codes, but are ready to use them in different clinical setting. In addition, 14,6% responded that when filling out medical death certificates they would not use any of the 4 specified codes. There is no agreement among physicians regarding the use of codes in clinical practice (Kendall's coefficient of concordance 0,084; p<0,001) and as a cause of death (0,148; p<0,001).Conclusion. There is no unified stance among doctors on the rules and applicability of using at least 4 codes (I25.0, I25.1, I25.8, I25.9). To correctly assess morbidity and mortality rates from individual forms of chronic ACAD based on ICD-10 codes, guidelines that should include a description and consideration of all the most significant clinical scenarios of chronic CAD should be developed.