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Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center
May Hua1,2, Guohua Li2,3, Caitlin Clancy1
11 Department of Anesthesiology, Columbia University , New York, New York.
Background:
Use of administrative data to study the effectiveness of specialized palliative care is limited by the lack of a reliable method to identify patients receiving palliative care consultation. The International Classification of Diseases, Ninth Revision (ICD-9) code V66.7 has been used, but its validity for this purpose is unknown.
Objective:
To examine the validity of the ICD-9 code V66.7 for identifying whether hospitalized patients received palliative care consultation.
Design:
Retrospective cohort study.
Setting/Subjects:
All patients of age ≥18 years admitted to a single academic medical center between August 2013 and August 2015.
Measurements:
Sensitivity and specificity of the V66.7 code for palliative care consultation for all patients and several a priori identified subgroups. The reference standard was the presence of a palliative care consultation note in the electronic medical record.
Results:
Of 100,910 admissions, 1999 received a palliative care consultation (2.0%) and 1846 (1.8%) had usage of the V66.7 code. Sensitivity and specificity for the V66.7 code were 49.9% and 99.1%, respectively. Sensitivity was considerably higher for certain subgroups, such as patients with dementia (76.3%) and metastatic cancer (66.3%); addition of age restrictions further improved sensitivity while maintaining high specificity. Specificity was substantially lower for patients who died during hospitalization (sensitivity 53.9%, specificity 75.1%).
Conclusions:
In a single center, the ICD-9 code V66.7 had poor sensitivity and high specificity for identifying hospitalized patients who received a palliative care consultation. Appropriate use of this code for this purpose should take these characteristics into consideration.
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