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Positive predictive values of ICD-9 codes to identify patients with stroke or TIA
Kari L Olson, Michele D Wood, Thomas Delate1
116601 E Centretech Parkway, Aurora, CO 80011.
Insights
Certain ICD-9 codes accurately identify patients with a history of stroke or transient ischemic attack (cerebral event). These codes can help focus care on high-risk individuals.
Area of Science:
- Medical Informatics
- Public Health
- Epidemiology
Background:
- Accurate identification of stroke and transient ischemic attack (cerebral event) history is crucial for patient management.
- Administrative data, including ICD-9 codes, are often used for patient cohort identification.
- The positive predictive value (PPV) of these codes can vary by care setting.
Purpose of the Study:
- To evaluate the positive predictive values (PPVs) of specific inpatient and outpatient ICD-9 codes and status code V12.54.
- To determine the accuracy of these codes in identifying confirmed cerebral events within a managed care organization.
Main Methods:
- Retrospective cohort study design.
- Analysis of inpatient hospital claims and outpatient visit records from January 1, 2001, to December 31, 2009.
- Calculation of PPVs for ICD-9 codes (430.XX-438.XX) and V12.54 based on care setting, using chart abstraction to confirm cerebral events.
Main Results:
- Reviewed 10,376 unique stroke codes for 4689 patients; 59.4% had confirmed cerebral events.
- Codes 434.XX, 433.X1, and V12.54 showed PPVs less than 90% when recorded in both inpatient and outpatient settings.
- Inpatient-only codes demonstrated higher PPVs, though captured fewer events.
Conclusions:
- Specific administrative ICD-9 codes (434.XX, 433.X1, V12.54) demonstrate high PPVs for identifying confirmed cerebral events.
- These codes can be integrated into probabilistic approaches to target patient care activities effectively.
- Utilizing these codes can optimize the identification of patients with a high likelihood of a cerebral event.
Objectives:
To determine the positive predictive values of inpatient and outpatient ICD-9 codes and status code V12.54 for identifying confirmed history of stroke or transient ischemic attack (cerebral event) among patients within a managed care organization.
Study Design:
Retrospective, cohort study.
Methods:
Inpatient hospital claims and outpatient visit records were used to identify patients with ICD-9 codes (430.XX to 438.XX) or status code V12.54 in the primary or secondary position recorded between January 1, 2001, and December 31, 2009. A standardized chart abstraction tool was used by trained chart abstractors blinded to the coding to confirm the cerebral event and classify stroke type. Positive predictive values (PPVs) were calculated for each code based on care setting.
Results:
A total of 4689 patients with 10,376 unique stroke codes recorded in the administrative data were reviewed. Of these, 2785 (59.4%) patients had a confirmed cerebral event. The codes with PPV less than 90% were 434.XX, 433 .X1, and V12.54 where codes were recorded in both the inpatient and outpatient settings. Overall, inpatient-only codes produced higher PPVs; however, relatively fewer events were captured in this setting.
Conclusions:
Administrative ICD-9 codes 434.XX, 433.X1, and V12.54 had consistently high PPVs in identifying patients with a confirmed cerebral event. These codes could be used as part of a probabilistic approach to focus care activities on patients with the highest likelihood of a cerebral event.
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