Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States |
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Authors: | Richard H White Martina Garcia Daniel J Tancredi Joanne Cuny Harriet Gammon Patrick S Romano |
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Institution: | a Division of General Medicine, University of California, Davis, USA b Center for Healthcare Policy and Research, University of California, Davis, USA c University HealthSystem Consortium, Chicago, Il, USA d The Joint Commission, Chicago, IL, USA |
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Abstract: | ObjectiveTo determine the positive predictive value of International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) discharge codes for acute deep vein thrombosis or pulmonary embolism.Materials and MethodsRetrospective review of 3456 cases hospitalized between 2005 and 2007 that had a discharge code for venous thromboembolism, using 3 sample populations: a single academic hospital, 33 University HealthSystem Consortium hospitals, and 35 community hospitals in a national Joint Commission study. Analysis was stratified by position of the code in the principal versus a secondary position.ResultsAmong 1096 cases that had a thromboembolism code in the principal position the positive predictive value for any acute venous thrombosis was 95% (95%CI:93-97), whereas among 2360 cases that had a thromboembolism code in a secondary position the predictive value was lower, 75% (95%CI:71-80). The corresponding positive predictive values for lower extremity deep-vein thrombosis or pulmonary embolism were 91% (95%CI:86-95) and 50% (95%CI:41-58), respectively. More highly defined codes had higher predictive value. Among codes in a secondary position that were false positive, 22% (95%CI:16-27) had chronic/prior venous thrombosis, 15% (95%CI:10-19) had an upper extremity thrombosis, 6% (95%CI:4-8) had a superficial vein thrombosis, and 7% (95%CI:4-13) had no mention of any thrombosis.ConclusionsICD-9-CM codes for venous thromboembolism had high predictive value when present in the principal position, and lower predictive value when in a secondary position. New thromboembolism codes that were added in 2009 that specify chronic thrombosis, upper extremity thrombosis and superficial venous thrombosis should reduce the frequency of false-positive thromboembolism codes. |
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Keywords: | VTE Venous thromboembolism ICD-9-CM International Classification of Diseases 9th Revision Clinical Modification POA Present on admission UHC University HealthSystem Consortium TJC The Joint Commission UC University of California UCDMC University of California Davis Medical Center UB-04 Uniform Claim and Billing Form 04 CI Confidence Interval |
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