Key result
ICD-10 coding identifies cardiogenic shock with ~88% positive predictive value and high sensitivity.
Why the study?
Many modern studies of cardiogenic shock rely on retrospective administrative datasets or electronic medical records, making it critically important to determine the positive predictive value and sensitivity of ICD-10-CM coding for valid case identification.
What are the positive predictive value and sensitivity of ICD-10-CM diagnosis codes for identifying cardiogenic shock in hospitalized patients?
Cohort (n=5,495)
No
What are the positive predictive value and sensitivity of ICD-10-CM diagnosis codes for identifying cardiogenic shock in hospitalized patients?
The ICD-10-CM code for cardiogenic shock has a high positive predictive value (88%) supporting its use in retrospective research, though its 84.7% sensitivity indicates that relying solely on coding misses a meaningful subset of clinical cases.
Answers are grounded in this paper and cite their sources.
Clinicians should combine ICD-10 codes with clinical criteria for cardiogenic shock; leaves open optimal hybrid algorithms for administrative datasets.
PURPOSE: Many modern studies of cardiogenic shock rely on retrospective administrative datasets or electronic medical records. This makes determination of coding accuracy of International Classification of Diseases, 10 Revision (ICD-10-CM) critically important for valid case identification. This study aimed to determine positive predictive value and sensitivity of ICD-10-CM coding of cardiogenic shock. METHODS: This retrospective cohort study identified all encounters admitted with cardiogenic shock between January 1, 2016 and Dec 31, 2022. Two non-overlapping cohorts were analyzed: those identified by ICD-10-CM code for cardiogenic shock and those who did not have an ICD-10-CM code but did have a primary diagnosis of heart failure, cardiomyopathy, myocardial infarction, and in whom either inotropes, pressors, or mechanical circulatory support devices were utilized. Based on chart review, the positive predictive value (PPV) as well as sensitivity for the ICD-10-CM code was calculated. RESULTS: There were 4473 individual encounters with an ICD-10-CM code for cardiogenic shock. Review of 100 charts by a cardiologist showed PPV of 88% (95% CI: 80%-93.6%). The cohort identified with clinical criteria without ICD-10-CM code consisted of 1022 patients. After review of all the patients in this cohort, the calculated PPV was 69.8% (95% CI 66.8%-72.6%). Utilizing this set as a false negative cohort, the sensitivity of ICD-10-CM code for cardiogenic shock was 84.7% (95% CI:83.4%-85.5%). The two cohorts were similar in age and sex. Race/ethnicity differed modestly while discharge disposition differed substantially. CONCLUSION: In this large, single health system validation study of 5495 patients, the ICD-10-CM code for cardiogenic shock demonstrated a high PPV of 88%. This supports the use of the ICD-10-CM code for administrative and retrospective research purposes. The calculated sensitivity of 84.7% shows that there is a meaningful proportion of patients with cardiogenic shock that are missed when utilizing only ICD-10-CM codes. Patients with and without the ICD-10-CM code differed in discharge outcomes. Future strategies should evaluate whether combining both ICD-10-CM codes and clinical criteria can improve cardiogenic shock case identification.
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Razi et al. (2026) conducted a cohort in Cardiogenic shock (n=5,495). ICD-10-CM diagnosis code for cardiogenic shock vs. Clinical criteria without ICD-10-CM code (primary diagnosis of HF, cardiomyopathy, or MI utilizing inotropes, pressors, or MCS) was evaluated on Positive predictive value (PPV) and sensitivity of ICD-10-CM coding for cardiogenic shock confirmed by chart review (95% CI 80%-93.6%). ICD-10-CM coding for cardiogenic shock demonstrated a positive predictive value of 88% (95% CI 80%-93.6%) and a sensitivity of 84.7% (95% CI 83.4%-85.5%).
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