Background: The 10th revision of International Classification of Disease, Clinical Modification (ICD10CM) increased the number of codes to identify nontraumatic subarachnoid hemorrhage from one to twenty-two. ICD10CM codes are able to specify the location of aneurysms causing subarachnoid hemorrhage (aSAH), however it is not clear how frequently or accurately these codes are being used in practice. Objective: To systematically evaluate the usage and accuracy of location-specific ICD10CM codes for aSAH. Methods: We extracted all uses of ICD10CM codes for nontraumatic subarachnoid hemorrhage (I60.x) during the first three years following the implementation of ICD10CM from the billing module of the EHR for UCHealth. For those codes that specified aSAH location (I60.0-I60.6), EHR documentation was reviewed to determine whether there was an active aSAH, any patient history of aSAH, or unruptured intracranial aneurysm/s and the locations of those outcomes. Results: Between October 1, 2015 and September 30, 2018, there were 3,119 instances of nontraumatic subarachnoid hemorrhage ICD10CM codes (I60.00-I60.9), of which 297 (9.5%) code instances identified aSAH location (I60.0-I60.6). These codes accurately identified current aSAH (64%), any patient history of aSAH (84%), and any patient history of intracranial aneurysm (87%). The accuracy of identified outcome location was 53% in current aSAH, 72% for any history of aSAH, and 76% for any history of an intracranial artery. Conclusions: Researchers should use ICD10CM codes with caution when attempting to detect active aSAH and/or aneurysm location. ### Competing Interest Statement The authors have declared no competing interest.
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