OBJECTIVES: This analysis was conducted to develop a comprehensive list of ICD-10 CM codes for underlying conditions identified by the CDC as being associated with high-risk of developing severe COVID-19 and assessed the consistency of these codes when applied to large US based datasets.

METHODS: The comprehensive list of ICD 10-CM codes for CDC-defined high-risk underlying conditions were mapped from CDC references and FDA Sentinel code lists. These codes were subsequently applied to Optum’s de-identified Clinformatics^® Data Mart Database (claims) and the Optum^® de-identified Electronic Health Record (EHR) database across 3 years (2018, 2019 and 2020) among continuously enrolled subjects > 12 years of age to determine the performance and consistency in identifying these high-risk underlying conditions annually over these years.

RESULTS: A total of 10,276 ICD-10 codes were mapped to 21 underlying conditions. Within the claims data, 62.7% of subjects > 12 years had > 1 CDC-defined high-risk condition (excluding age) with 26.6% of patients > 65 years while in the EHR data 38% had > 1 high-risk underlying condition (excluding age) with 14.4% > 65 years. These results were similar and consistent in both datasets across all years. Patients aged 12-64 years in the claims data had a higher rate of >1 high risk underlying condition relative to the EHR data, 49.3% and 34%, respectively. The top 5 conditions among the > 65 were identical across both databases: hypertension, immunocompromised status, heart conditions, diabetes (type 1 or 2), and overweight/obesity. The top 5 conditions among the 12-64 age group were also similar among the databases and included: immunocompromised status, hypertension, overweight/obesity, smoking (current or former), and mental health conditions.

CONCLUSIONS: These findings present a comprehensive list of codes that can be used by researchers, clinicians and policy makers to identify and characterize patients that may be at high-risk for severe COVID-19 outcomes.