title: Emergency department coding of bicycle and pedestrian injuries during the transition from ICD-9 to ICD-10.
abstract: BACKGROUND
  The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes).
  
  
  OBJECTIVE
  To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10.
  
  
  METHODS
  Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated.
  
  
  RESULTS
  Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10.
  
  
  CONCLUSIONS
  Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Karkhaneh
authors.forename: B E
authors.initials: BE
authors.lastname: Hagel
authors.forename: A
authors.initials: A
authors.lastname: Couperthwaite
authors.forename: L D
authors.initials: LD
authors.lastname: Saunders
authors.forename: D C
authors.initials: DC
authors.lastname: Voaklander
authors.forename: B H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000416:Alberta; D001642:Bicycling / Q000293:injuries*; D004636:Emergency Service, Hospital; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards*; D011159:Population Surveillance / Q000379:methods*; D015203:Reproducibility of Results; D016138:Walking / Q000293:injuries*; D014947:Wounds and Injuries / Q000145:classification