Abstract Details

Title The Predictive Value of Billing Codes and Treatment Data to Identify Relapse Hospitalizations among Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD)

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-013

Objective To identify the combination of hospitalization billing codes and treatments that best distinguishes relapse from non-relapse hospitalizations among patients with NMOSD.

Background

Patients with NMOSD may be hospitalized for relapse or non-relapse (e.g., treatment-related complications, unrelated comorbidities) events. There are no real-world studies validating hospitalization billing codes to predict relapse-associated hospitalizations among patients with NMOSD.

Design/Methods Patients with NMOSD hospitalized within a healthcare system between January 2016 and March 2025 were included. Each hospitalization was adjudicated as relapse (admission for a core demyelinating event) or non-relapse (clear alternate etiology and/or no new clinical or imaging evidence of relapse) by a neuroimmunologist. For each hospitalization, ICD-9 and 10 billing codes associated with neuroinflammatory events (NMOSD, optic neuritis, transverse myelitis, other neuroinflammatory disorders [ONID]) and common infections were examined, and administration of acute immunotherapy was reviewed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for predicting relapse hospitalization were calculated for 40 combinations of billing codes and treatments.

Results 53 patients -- median age of 53, 77% female, 84% seropositive -- with 133 hospitalizations (52 [39.1%] relapses, 81 [60.9%] non-relapses) were included. The NMOSD billing code alone (G26.0 or 341.0) showed a sensitivity, specificity, PPV, and NPV of 75.0%, 70.4%, 61.9%, and 81.4%, respectively. The combination of NMOSD or ON or TM or ONID codes with intravenous (IV) steroid treatment (without consideration of infection) yielded the best predictive value (sensitivity 96.5%, specificity 77.8%, PPV 77.8%, NPV 90.0%). In general, the addition of other immunotherapies and the absence of infection increased specificity but decreased sensitivity.

Conclusions The NMOSD billing code alone only moderately predicts relapse hospitalization in NMOSD patients, while the combination of NMOSD or ON or TM or ONID billing codes with IV steroid use best predicts relapse hospitalizations. This variability underscores the need to validate billing codes to facilitate accurate real-world NMOSD research.

Authors/Disclosures
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital) PRESENTER	Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
Mattia Wruble, MD	The institution of Dr. Wruble has received research support from Alexion. The institution of Dr. Wruble has received research support from Roche.
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital)	Dr. Bilodeau has nothing to disclose.
Sathya Narasimhan, MD (Baylor College of Medicine)	Dr. Narasimhan has nothing to disclose.
Danielle Kei Pua, MD (Westchester Medical Center)	Dr. Pua has nothing to disclose.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School)	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.

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