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Validity of ICD-9-CM codes for the identification of complications related to central venous catheterization

Melissa H Tukey1, Ann M Borzecki2, Renda Soylemez Wiener3

  • 1Boston University, Boston, MA mtukey@bu.edu.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|December 18, 2013
PubMed

Insights

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for central venous catheterization (CVC) complications show low sensitivity for detecting iatrogenic pneumothorax and central line-associated bloodstream infection (CLABSI). Their validity for research and pay-for-performance is questionable.

Area of Science:

  • Medical Informatics
  • Health Services Research
  • Patient Safety

Background:

  • Central venous catheterization (CVC) is associated with serious complications like iatrogenic pneumothorax and central line-associated bloodstream infection (CLABSI).
  • International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes are increasingly utilized for healthcare research and performance evaluation.
  • The accuracy of ICD-9-CM codes in identifying CVC complications has not been rigorously validated.

Purpose of the Study:

  • To evaluate the validity of ICD-9-CM codes for detecting iatrogenic pneumothorax and CLABSI following CVC placement.
  • To assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these codes.

Main Methods:

  • A retrospective review of discharge records from a single hospital was conducted for CVCs placed between July 2010 and December 2011.
  • Complications identified by ICD-9-CM codes were compared against those confirmed through detailed medical record abstraction.
  • Performance metrics including sensitivity, specificity, PPV, and NPV were calculated for each complication code.

Main Results:

  • The ICD-9-CM code for iatrogenic pneumothorax demonstrated high specificity (100%) and NPV (99.5%), but moderate sensitivity (66.7%) and perfect PPV (100%).
  • ICD-9-CM codes for CLABSI exhibited high specificity (99.0%) and NPV (99.2%), but low sensitivity (33.3%) and poor PPV (28.6%).

Conclusions:

  • The low sensitivity and variable PPV of ICD-9-CM codes for detecting CVC complications raise significant concerns regarding their reliability.
  • Findings suggest caution when using these codes for research studies or pay-for-performance initiatives related to CVC complications.

Keywords:
ICD-9-CM codesbacteremiacentral venous catheterspneumothorax

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