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Background <p>Accurate identification of COVID-19 cases is essential for real-world studies. This study assessed the validity of ICD-10-CM code U07.1 for identifying COVID-19 cases in administrative claims data in Taiwan.</p> Methods <p>This observational validation study linked National Health Insurance claims with laboratory-confirmed SARS-CoV-2 RT-PCR results from a multi-institutional database. We included 127,300 outpatient, emergency, and inpatient encounters from 2022. Positive and negative predictive values (PPV, NPV), sensitivity, and specificity were calculated using RT-PCR results as the reference standard, with stratified analyses conducted by clinical setting, time period, patient demographics, and hospital level.</p> Results <p>Overall, the U07.1 code demonstrated high PPV (95.3%) and specificity (99.5%), but moderate NPV (77.9%) and low sensitivity (26.6%). While PPVs remained consistently high across all clinical settings (&gt; 91%), NPVs varied significantly, being lowest in outpatient visits (41.3%). Temporally, NPV and sensitivity were lowest during April–June 2022 (57.7% and 14.9%, respectively), coinciding with the peak outbreak and the transition toward antigen-based diagnostic policies. Sensitivity was markedly higher among inpatients (84.4%) and older adults aged ≥ 80 years (60.5%) compared to younger populations.</p> Conclusion <p>ICD-10-CM U07.1 is a highly reliable marker for identifying confirmed COVID-19 cases in Taiwan’s claims data. However, the low overall sensitivity and substantial variability in NPV suggest significant under-capture of mild infections, particularly in outpatient settings. Researchers should exercise caution when using this code to estimate total disease burden or when defining code-negative control cohorts.</p>

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Validation of ICD-10-CM diagnosis codes for identifying COVID-19 cases using administrative claims data in Taiwan

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月23日

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  • Wei-Lun Chang,
  • Chia-Ling Wu,
  • Cheng-Hsun Chiu,
  • Yu-Tung Huang

摘要

Background

Accurate identification of COVID-19 cases is essential for real-world studies. This study assessed the validity of ICD-10-CM code U07.1 for identifying COVID-19 cases in administrative claims data in Taiwan.

Methods

This observational validation study linked National Health Insurance claims with laboratory-confirmed SARS-CoV-2 RT-PCR results from a multi-institutional database. We included 127,300 outpatient, emergency, and inpatient encounters from 2022. Positive and negative predictive values (PPV, NPV), sensitivity, and specificity were calculated using RT-PCR results as the reference standard, with stratified analyses conducted by clinical setting, time period, patient demographics, and hospital level.

Results

Overall, the U07.1 code demonstrated high PPV (95.3%) and specificity (99.5%), but moderate NPV (77.9%) and low sensitivity (26.6%). While PPVs remained consistently high across all clinical settings (> 91%), NPVs varied significantly, being lowest in outpatient visits (41.3%). Temporally, NPV and sensitivity were lowest during April–June 2022 (57.7% and 14.9%, respectively), coinciding with the peak outbreak and the transition toward antigen-based diagnostic policies. Sensitivity was markedly higher among inpatients (84.4%) and older adults aged ≥ 80 years (60.5%) compared to younger populations.

Conclusion

ICD-10-CM U07.1 is a highly reliable marker for identifying confirmed COVID-19 cases in Taiwan’s claims data. However, the low overall sensitivity and substantial variability in NPV suggest significant under-capture of mild infections, particularly in outpatient settings. Researchers should exercise caution when using this code to estimate total disease burden or when defining code-negative control cohorts.