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The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals
Anneka M Hooft1, Andrea G Asnes1, Nina Livingston2
1Department of Pediatrics, Yale School of Medicine, New Haven, Conn.
Insights
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes have low accuracy in identifying child physical abuse cases. This suggests both undercounting and overcounting of abuse, impacting accurate case identification.
Area of Science:
- Pediatrics
- Public Health
- Medical Informatics
Background:
- Accurate identification of child physical abuse is crucial for intervention and prevention.
- International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are used in hospital databases to classify diagnoses.
- The reliability of ICD-9-CM codes for identifying child abuse has not been thoroughly evaluated.
Purpose of the Study:
- To assess the accuracy of ICD-9-CM codes in identifying child physical abuse cases.
- To compare ICD-9-CM code accuracy across four children's hospitals.
- To identify factors contributing to coding discrepancies in child abuse cases.
Main Methods:
- Retrospective review of 936 suspected child physical abuse cases from 2007-2010.
- Comparison of hospital ICD-9-CM codes with assessments by child abuse pediatricians (CAPs).
- Calculation of sensitivity and specificity; abstraction of discordant cases for further analysis.
Main Results:
- ICD-9-CM codes demonstrated a sensitivity of 73.5% and specificity of 92.4% for identifying child abuse.
- Sensitivity varied significantly between hospitals (53.8% to 83.8%), while specificity was high (85.4% to 100%).
- Variations in coding practices and physician documentation contributed to discrepancies.
Conclusions:
- ICD-9-CM codes have relatively low sensitivity and high specificity for identifying child physical abuse.
- The findings suggest potential under- and overcounting of abuse cases due to coding inaccuracies.
- Improved coding practices and documentation are needed for more accurate child abuse case identification.
Objective:
To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals.
Methods:
We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies.
Results:
Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse.
Conclusions:
Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.
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