Discordance between
ICD
‐10‐
AM
coding and confirmed prevalence of
MASLD
in a quaternary diabetes
Janakan Selvarajah, Maddison Terlato, Weilun Gao, Omar Salehi, Christine Lu, Faris Gondal, Karen Lu, Angela Zhu, Spiros Fourlanos, Ashok S. Raj 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/m 2 , 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.