Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018

Catarina de Paraíso Camarinha; Maria Miguel Gomes Oliveira; Cecília Elias; Miguel de Araújo Nobre; Leonor Bacelar Costa Nicolau; Cristina Furtado; Andreia Silva da Costa; Paulo Jorge da Silva Nogueira

doi:10.1016/j.imu.2025.101626

Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018

Catarina de Paraíso Camarinha^*, Maria Miguel Gomes Oliveira, Cecília Elias, Miguel de Araújo Nobre, Leonor Bacelar Costa Nicolau, Cristina Furtado, Andreia Silva da Costa, Paulo Jorge da Silva Nogueira

^*Corresponding author for this work

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Abstract

Background: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.

Original language	English
Article number	101626
Number of pages	9
Journal	Informatics in Medicine Unlocked
Volume	53
DOIs	https://doi.org/10.1016/j.imu.2025.101626
Publication status	Published - Jan 2025

Keywords

Coding transition
Delivery hospitalizations
ICD-10-CM
ICD-9-CM
Maternal health surveillance
Portugal

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Camarinha, C. D. P., Oliveira, M. M. G., Elias, C., Nobre, M. D. A., Nicolau, L. B. C., Furtado, C., Costa, A. S. D., & Nogueira, P. J. D. S. (2025). Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018. Informatics in Medicine Unlocked, 53, Article 101626. https://doi.org/10.1016/j.imu.2025.101626

@article{87f1ffd642aa4f31aca0e1e7bd470847,

title = "Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018",

abstract = "Background: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.",

keywords = "Coding transition, Delivery hospitalizations, ICD-10-CM, ICD-9-CM, Maternal health surveillance, Portugal",

author = "Camarinha, \{Catarina de Para{\'i}so\} and Oliveira, \{Maria Miguel Gomes\} and Cec{\'i}lia Elias and Nobre, \{Miguel de Ara{\'u}jo\} and Nicolau, \{Leonor Bacelar Costa\} and Cristina Furtado and Costa, \{Andreia Silva da\} and Nogueira, \{Paulo Jorge da Silva\}",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

month = jan,

doi = "10.1016/j.imu.2025.101626",

language = "English",

volume = "53",

journal = "Informatics in Medicine Unlocked",

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T1 - Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018

AU - Camarinha, Catarina de Paraíso

AU - Oliveira, Maria Miguel Gomes

AU - Elias, Cecília

AU - Nobre, Miguel de Araújo

AU - Nicolau, Leonor Bacelar Costa

AU - Furtado, Cristina

AU - Costa, Andreia Silva da

AU - Nogueira, Paulo Jorge da Silva

PY - 2025/1

Y1 - 2025/1

N2 - Background: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.

AB - Background: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition. Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition. Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable. Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.

KW - Coding transition

KW - Delivery hospitalizations

KW - ICD-10-CM

KW - ICD-9-CM

KW - Maternal health surveillance

KW - Portugal

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U2 - 10.1016/j.imu.2025.101626

DO - 10.1016/j.imu.2025.101626

M3 - Article

AN - SCOPUS:85217641891

SN - 2352-9148

VL - 53

JO - Informatics in Medicine Unlocked

JF - Informatics in Medicine Unlocked

M1 - 101626

ER -

Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018

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Keywords

UN SDGs

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CRC-W: Católica Research Centre for Psychological, Family and Social Wellbeing

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Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018

Abstract

Keywords

UN SDGs

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CRC-W: Católica Research Centre for Psychological, Family and Social Wellbeing

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