%0 Journal Article
%@ 1947-2579
%I JMIR Publications
%V 16
%N 
%P e53445
%T Characterization of Post–COVID-19 Definitions and Clinical Coding Practices: Longitudinal Study
%A Maripuri,Monika
%A Dey,Andrew
%A Honerlaw,Jacqueline
%A Hong,Chuan
%A Ho,Yuk-Lam
%A Tanukonda,Vidisha
%A Chen,Alicia W
%A Panickan,Vidul Ayakulangara
%A Wang,Xuan
%A Zhang,Harrison G
%A Yang,Doris
%A Samayamuthu,Malarkodi Jebathilagam
%A Morris,Michele
%A Visweswaran,Shyam
%A Beaulieu-Jones,Brendin
%A Ramoni,Rachel
%A Muralidhar,Sumitra
%A Gaziano,J Michael
%A Liao,Katherine
%A Xia,Zongqi
%A Brat,Gabriel A
%A Cai,Tianxi
%A Cho,Kelly
%+ Veterans Affairs Boston Healthcare System, 2 Avenue de Lafayette, Boston, MA, 02111, United States, 1 617 390 6976, monika.maripuri@va.gov
%K veterans
%K long COVID-19
%K postacute sequelae of SARS-CoV-2
%K PASC
%K International Classification of Diseases
%K U09.9 ICD-10 code
%K algorithm validation
%K chart review
%K electronic health records
%K COVID-19
%D 2024
%7 3.5.2024
%9 Original Paper
%J Online J Public Health Inform
%G English
%X Background: Post–COVID-19 condition (colloquially known as “long COVID-19”) characterized as postacute sequelae of SARS-CoV-2 has no universal clinical case definition. Recent efforts have focused on understanding long COVID-19 symptoms, and electronic health record (EHR) data provide a unique resource for understanding this condition. The introduction of the International Classification of Diseases, Tenth Revision (ICD-10) code U09.9 for “Post COVID-19 condition, unspecified” to identify patients with long COVID-19 has provided a method of evaluating this condition in EHRs; however, the accuracy of this code is unclear. Objective: This study aimed to characterize the utility and accuracy of the U09.9 code across 3 health care systems—the Veterans Health Administration, the Beth Israel Deaconess Medical Center, and the University of Pittsburgh Medical Center—against patients identified with long COVID-19 via a chart review by operationalizing the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) definitions. Methods: Patients who were COVID-19 positive with either a U07.1 ICD-10 code or positive polymerase chain reaction test within these health care systems were identified for chart review. Among this cohort, we sampled patients based on two approaches: (1) with a U09.9 code and (2) without a U09.9 code but with a new onset long COVID-19–related ICD-10 code, which allows us to assess the sensitivity of the U09.9 code. To operationalize the long COVID-19 definition based on health agency guidelines, symptoms were grouped into a “core” cluster of 11 commonly reported symptoms among patients with long COVID-19 and an extended cluster that captured all other symptoms by disease domain. Patients having ≥2 symptoms persisting for ≥60 days that were new onset after their COVID-19 infection, with ≥1 symptom in the core cluster, were labeled as having long COVID-19 per chart review. The code’s performance was compared across 3 health care systems and across different time periods of the pandemic. Results: Overall, 900 patient charts were reviewed across 3 health care systems. The prevalence of long COVID-19 among the cohort with the U09.9 ICD-10 code based on the operationalized WHO definition was between 23.2% and 62.4% across these health care systems. We also evaluated a less stringent version of the WHO definition and the CDC definition and observed an increase in the prevalence of long COVID-19 at all 3 health care systems. Conclusions: This is one of the first studies to evaluate the U09.9 code against a clinical case definition for long COVID-19, as well as the first to apply this definition to EHR data using a chart review approach on a nationwide cohort across multiple health care systems. This chart review approach can be implemented at other EHR systems to further evaluate the utility and performance of the U09.9 code. 
%M 38700929
%R 10.2196/53445
%U https://ojphi.jmir.org/2024/1/e53445
%U https://doi.org/10.2196/53445
%U http://www.ncbi.nlm.nih.gov/pubmed/38700929