Validity of Using Billing Codes from Electronic Health Records to Estimate Skin Cancer Counts

Abstract

Importance: Patients can develop multiple skin cancers, and their medical data can be spread over multiple health care systems. This fragmented care, combined with the lack of skin cancer registries, has limited our ability both to provide accurate estimates of incidence and to study the pathogenesis of multiple skin cancers. Objective: To assess whether standard diagnostic and procedural codes present in the electronic health records at a single health care system are a valid proxy for estimating the number of overall skin cancers. Design, Setting, and Participants: Retrospective cohort study of patients seen at a single-center tertiary care hospital (ie, Vanderbilt University Medical Center) between July 1, 2008, and June 30, 2018. All patients with at least 1 electronic health record-based diagnostic or procedural code for any skin cancer and at least 1 pathology report of a skin cancer. Exposure: The number of International Classification of Disease (ICD) or Current Procedural Terminology (CPT) codes relating to skin cancer. Main Outcomes and Measures: Pearson correlation coefficient and R2were calculated for the total number of ICD or CPT codes for skin cancer and histologically verified skin cancers. Results: In this cohort study of 35901 patients, the mean (SD) age was 70.4 (14.4) years, 20404 (56.8%) were men, and 31623 (88.1%) were White individuals. Of these patients, 6307 had at least 1 ICD or CPT code or pathology report for a skin cancer, of whom 5688 patients had both a CPT code related to skin malignancy and a histologically verified skin cancer. There was a strong linear correlation between the number of CPT codes and pathology records (r = 0.87). There was a poor correlation between the number of ICD codes and pathology records (r = 0.22). Conclusions and Relevance: This cohort study found that the use of ICD codes was a poor proxy measure for the number of skin cancers per patient. In contrast, CPT codes accounted for more than 75% of the variability in the number of skin cancers (R2= 0.76) and were a better proxy measure for the total number of skin cancers per patient..