Discordance between ICD-10-AM coding and confirmed prevalence of MASLD in a quaternary diabetes service.

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2026-09-20 DOI:10.1111/imj.70587

Janakan Selvarajah, Maddison Terlato, Weilun Gao, Omar Salehi, Christine Lu, Faris Gondal, Karen Lu, Angela Zhu, Spiros Fourlanos, Ashok S Raj

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引用次数: 0

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease, affects an estimated 30%-70% of people with type 2 diabetes (T2D), with prevalence likely to be higher in quaternary diabetes clinics. Documentation using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) may substantially underestimate disease burden.

Aims: To compare the prevalence of MASLD identified by ICD-10-AM coding with imaging-based diagnosis using transient elastography (FibroScan®) and determine disease severity and clinical characteristics associated with significant fibrosis.

Methods: Adults attending a quaternary diabetes clinic underwent retrospective review of electronic health records (August 2020-December 2023) for ICD-10-AM-coded MASLD, excluding other chronic liver diseases. A prospective cohort of consecutive clinic attendees underwent FibroScan® assessment for imaging-based diagnosis of MASLD and fibrosis staging. Clinical characteristics associated with significant fibrosis were analysed.

Results: ICD-10-AM coding identified MASLD in 3% (85/2589) of patients, compared with 83% (81/103) diagnosed by FibroScan®. Significant fibrosis was present in 45% (46/103). Patients with significant fibrosis had higher body mass index (34 vs 28 kg/m², P < 0.01), alanine aminotransferase (40 vs 26 U/L, P < 0.001), gamma-glutamyl transferase (54 vs 30 U/L, P < 0.001), lower high-density lipoprotein cholesterol (1.03 vs 1.15 mmol/L, P = 0.04), younger age (62 vs 67 years, P = 0.05) and shorter diabetes duration (11 vs 18 years, P = 0.02).

Conclusions: In this quaternary diabetes clinic, ICD-10-AM coding substantially under-recognised MASLD compared with FibroScan®, which identified a high prevalence of MASLD and significant fibrosis. These findings highlight important gaps in diagnostic coding and clinical awareness of MASLD in T2D.

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ICD-10-AM编码与第四纪糖尿病确诊的MASLD患病率之间的不一致。

背景：代谢功能障碍相关脂肪变性肝病（MASLD），以前称为非酒精性脂肪性肝病，影响了估计30%-70%的2型糖尿病（T2D）患者，在第四代糖尿病诊所的患病率可能更高。使用《国际疾病分类，第十次修订，澳大利亚修订版》（ICD-10-AM）的文件可能大大低估了疾病负担。目的：比较ICD-10-AM编码识别的MASLD患病率与基于成像的瞬时弹性成像（FibroScan®）诊断，并确定与显著纤维化相关的疾病严重程度和临床特征。方法：在一家第四代糖尿病诊所就诊的成年人对icd -10- am编码MASLD的电子健康记录（2020年8月至2023年12月）进行回顾性审查，不包括其他慢性肝病。连续临床参与者的前瞻性队列接受了FibroScan®评估，以基于影像学诊断MASLD和纤维化分期。分析与显著纤维化相关的临床特征。结果：ICD-10-AM编码识别出MASLD的患者为3%(85/2589)，而FibroScan®诊断出MASLD的患者为83%（81/103）。45%（46/103）存在显著纤维化。结论：在这个第四代糖尿病临床中，与FibroScan®相比，ICD-10-AM编码的MASLD基本上未被识别，后者确定了MASLD的高患病率和显著纤维化。这些发现突出了T2D中MASLD的诊断编码和临床意识的重要差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.