Accuracy of malignant hyperthermia diagnoses in hospital discharge records
Teeda Pinyavat1, Henry Rosenberg, Barbara H Lang
1From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York (T.P., B.H.L.); Department of Medical Education and Clinical Research, Saint Barnabas Medical Center, Livingston, New Jersey (H.R.); Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (C.A.W.); Department of Anesthesiology, Toronto General Hospital, Toronto, Ontario, Canada (S.R.); Departments of Anesthesiology and Epidemiology, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, New York (J.E.B., G.L.); and Departments of Anesthesiology and Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York (L.S.S.).
Background:
In 1997, the International Classification of Diseases (ICD), 9th Revision Clinical Modification (ICD-9) coding system introduced the code for malignant hyperthermia (MH) (995.86). The aim of this study was to estimate the accuracy of coding for MH in hospital discharge records.
Methods:
An expert panel of anesthesiologists reviewed medical records for patients with a discharge diagnosis of MH based on ICD-9 or ICD-10 codes from January 1, 2006 to December 31, 2008 at six tertiary care medical centers in North America. All cases were categorized as possible, probable, or fulminant MH, history of MH (family or personal) or other.
Results:
A total of 47 medical records with MH diagnoses were reviewed; 68.1% had a documented surgical procedure and general anesthesia, and 23.4% (95% CI, 12.3-38.0%) had a possible, probable, or fulminant MH event. Dantrolene was given in 81% of the MH events. All patients judged to have an incident MH event survived to discharge. Family and personal history of MH accounted for 46.8% of cases. High fever without evidence of MH during admission accounted for 23.4%, and the reason for MH coding was unclear in 6.4% of cases.
Conclusions:
Approximately one quarter of ICD-9 or ICD-10 coded MH diagnoses in hospital discharge records refer to incident MH episodes and an additional 47% to MH susceptibility (including personal history or family history). Information such as surgical procedure, anesthesia billing data, and dantrolene administration may aid in identifying incident MH cases among those with an ICD-9 or ICD-10 coded MH diagnosis in their hospital discharge records.
Insights
Accurate coding for malignant hyperthermia (MH) in hospital records is crucial. This study found only about a quarter of MH diagnoses represent actual MH events, with many indicating susceptibility.
Area of Science:
- Anesthesiology
- Medical Informatics
- Patient Safety
Background:
- Malignant hyperthermia (MH) coding was introduced in 1997 under the ICD-9 system.
- Accurate coding is essential for patient safety and epidemiological studies.
- This study aimed to assess the accuracy of MH coding in hospital discharge records.
Purpose of the Study:
- To evaluate the accuracy of malignant hyperthermia (MH) coding in hospital discharge records.
- To determine the proportion of coded MH diagnoses that represent actual MH events versus susceptibility or other conditions.
- To identify factors that could improve the identification of true MH cases.
Main Methods:
- Expert anesthesiologist panel reviewed 47 medical records with MH diagnoses (ICD-9/ICD-10).
- Records spanned January 2006 to December 2008 from six North American tertiary care centers.
- Cases were classified as possible, probable, or fulminant MH, MH history, or other.
Main Results:
- Only 23.4% of coded MH diagnoses represented actual MH events.
- MH susceptibility (personal/family history) accounted for 46.8% of cases.
- Dantrolene was administered in 81% of MH events; all patients survived.
Conclusions:
- Approximately 25% of coded MH diagnoses in hospital records signify incident MH episodes.
- An additional 47% of codes relate to MH susceptibility.
- Utilizing surgical, anesthesia, and dantrolene data can help identify true MH cases.
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