1085 Educational intervention to increase utilization of ICD-10 codes for immune-related adverse events: a quality improvement initiative
Year: 2026
Type: conference-abstract
Abstract: Background Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment but can cause immune-related adverse events (irAEs). Accurate ICD-10 coding of irAEs is important for clinical care, pharmacovigilance, and research, yet remains underutilized. On October 1st 2024, four new ICD.10 codes were introduced to improve documentation of ICI exposure and toxicity; Z92.26 (personal history of ICI use), T45.AX5A (adverse effect of ICI, initial encounter), T45.AX5D (adverse effect of ICI, subsequent encounter), T45.AX5S (adverse effect of ICI, sequelae).Methods We conducted a quality improvement initiative aimed at increasing adoption of the new ICD-10 codes. Our intervention included virtual educational sessions reviewing code indications, clinical applications, and documentation workflows. Sessions were conducted with the thoracic oncology advanced practice providers (APPs) on 1/6/26, and melanoma providers on 3/24/26. The primary aim was to increase use of the new codes by 20% within 3 months and 40% within 6 months. An interim analysis compared code utilization among all EMR encounters two months before and after each educational intervention.Results Interim analysis at two months following the intervention demonstrated increased utilization of all ICD codes numerically for both groups. Among the thoracic group, there was an increase in the use of code Z92.26 from 21 to 26 (23.8%), code T45.AX5A from 4 to 11 (175%), and code T45.AX5D from 6 to 8 (33%) (n = 4,480,691 encounters 2 months prior to the intervention, n = 4,750,501 encounters 2 months after). For the melanoma group, there was an increase in the use of code Z92.26 from 25 to 27 (8%), code T45.AX5A from 16 to 27 (68.8%), and code T45.AX5D from 5 to 9 (80%) (n = 4,588,290 encounters 2 months prior to the intervention, n = 4,828,950 encounters 2 months after). In both groups, there were 0 encounters for the code T45.AX5S during all time periods. As this analysis was performed before the pre-specified 3-month evaluation period and reflects early implementation data, the study was not designed or powered to assess achievement of the primary improvement target at this time.Conclusions Early post- intervention data demonstrate increased numerical utilization of newly introduced ICD-10 codes for ICI-related toxicities across provider groups. While statistical significance was not observed in this interim analysis, the findings suggest successful early adoption and support continued implementation efforts. Although formal evaluation of the primary endpoint is ongoing, these findings support education as a practical first step toward improving institutional adoption of standardized irAE coding.
Authors: Asha E Kodan, Aliyah Pabani
Institution: Johns Hopkins University
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,490
OpenAlex ID: W7225159393