Author(s)
Anas M. Qatanani, MD
Michelle Pistner Nixon. PhD
Mudit Gupta, MS
Jennifer Rager, DO
Amanda Young, MS
Kenneth Altman, MD, PhD, MBA
Affiliation(s)
Geisinger Health System
Abstract:
Background/Objectives: Management of chronic cough requires best practices, and accurate ICD-10 coding is essential to target improvements in care and achieve optimal outcomes. We performed a population health approach to address coding accuracy and determine if cough chronicity is associated with greater number of individual patient encounters.
Methods: An IRB-exempt population-based retrospective electronic record review was performed to analyze encounters for cough in an integrated rural healthcare system from January 1, 2021, through December 31, 2023. Encounters were manually reviewed to determine chronicity and assess best practices of chest radiography and angiotensin converting enzyme inhibitor (ACEi) use. We also compared ICD-10 codes with chart review to determine accuracy of coding.
Results: There were 101,635 patients included, involving 145,428 total encounters (57.6% female, median age 40.07). A power analysis defined 314 patients with differing numbers of encounters for manual chart review. Analysis showed chronic cough in 58.69% by the third encounter, 78.57% at the fourth encounter, and 75.00% at the fifth encounter. Chronic cough patients received chest radiography 58.4% of the time, but they did not routinely undergo evaluation of ACEi usage (9.73% of patients with chronic cough). The overall accuracy of ICD-10 coding for acute vs chronic cough was 77.7% (sensitivity 56.2%, specificity 89.8%), which increased to 88.9% by the fifth encounter.
Conclusion: This study demonstrates that likelihood of cough chronicity increases as number of encounters for cough increases in our study period and population. However, there remain opportunities to educate practitioners regarding best practices and accurate coding.