Background: Clinically, cough is classified by the duration which has implications for diagnosis and subsequent treatment. For example, chronic coughs lasting more than eight weeks, such as those related to allergies or gastroesophageal reflux disease, will have very different implications than acute coughs that less three weeks, such as those caused by the common cold. Prior to fiscal year (FY) 2022, cough was just one ICD-10-CM code (R05) which did not allow for coders and researchers to distinguish between the different durations of cough. However, starting in FY 2022, the codes now can discern between acute cough (R05.1), subacute cough (R05.2), chronic cough (R05.3), cough syncope (R05.4), other specified cough (R05.8) and unspecified cough (R05.9).
Methods: The Vizient™ Clinical Data Base was queried for ICD-10-CM codes for cough (R05*) for admissions during fiscal years 2020 to 2022.
Results: Between FY 2020 and 2022 there were 154,353 inpatient admissions with a diagnosis of cough. Of the six new cough codes, unspecified cough (R05.9) was used the most (68.7%) followed by chronic cough (R05.3 – 26.1%), and other specified cough (R05.8 – 3.9%). Most codes for cough were approximately half male and half female; however, R05.4 cough syncope was 76.2% male. Cough syncope had more Non-Hispanic Black (23.8%) patients compared to the other diagnosis codes (average 18.0%) and the previous ICD-10 code (19.8%). The different cough diagnoses had different reasons for care – for FY19/20, the top three were MSDRG 871 septicemia or severe sepsis, MS-DRG 177 respiratory infections and inflammation and MSDRG 885 psychoses. The top MSDRG category for acute cough was MS-DRG 177 respiratory infections and inflammation; the top MSDRG category for subacute cough was MSDRG 204 respiratory signs and symptoms; the top MSDRG category for chronic cough was MSDRG 871 septicemia or severe sepsis. The acute cough group had the highest in-hospital death rate (3.0%) compared to lowest in the subacute cough group (1.3%). The average LOS for patients with cough in FY19/20 was 7.4 days; with the expanded codes, the longest LOS was in the acute cough group at 9.1 days and the shortest was in the subacute cough group at 6.6 days. The average age for patients with cough in FY19/20 was 58.9 years; with the expanded codes, the youngest average age was in the unspecified cough group at 58.0 years and the oldest average age was in the subacute cough group at 65.2 years.
Conclusions: Being able to discern between different levels and durations of coughs can lead to more clinical insight in administrative claims. It is evident that there are differences in main reason for care, age, LOS, race and sex among the different cough diagnoses that could indicate opportunities for evaluation and intervention that change based on presentation of the patient.