How Well Do ICD-9-CM Codes Predict True Congenital Heart Defects? A Centers for Disease Control and Prevention-Based

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Fred H Rodriguez1,2, Cheryl L Raskind-Hood1, Trenton Hoffman1

  • 1Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA.

Journal of the American Heart Association
|July 21, 2022
PubMed

Insights

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes show a 76.36% positive predictive value (PPV) for identifying congenital heart defects (CHD). While acceptable, further algorithm development is needed for accurate CHD case identification.

Area of Science:

  • Public Health
  • Epidemiology
  • Medical Informatics

Background:

  • The Centers for Disease Control and Prevention's Surveillance of Congenital Heart Defects Across the Lifespan project utilizes large clinical and administrative databases.
  • Accurate coding of congenital heart defects (CHD) is crucial for estimating population prevalence and understanding epidemiology.
  • This project aims to validate the accuracy of ICD-9-CM codes for CHD surveillance.

Purpose of the Study:

  • To assess the positive predictive value (PPV) of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying congenital heart defect (CHD) cases.
  • To evaluate the accuracy of ICD-9-CM codes in classifying different anatomic groups of CHD.
  • To determine if PPV varies by CHD severity and patient age.

Main Methods:

  • A validation study was conducted on 774 cases from 4 surveillance sites.
  • The study assessed the PPV of 57 ICD-9-CM codes related to CHD.
  • Chi-square tests were used to analyze differences in PPV by CHD severity and age groups.

Main Results:

  • The overall PPV for identifying a true CHD case using ICD-9-CM codes was 76.36%.
  • PPVs were higher for complex CHD (89.85%), shunt (86.73%), and valve (82.99%) categories compared to "Other" CHD (44.39%).
  • ICD-9-CM codes demonstrated higher PPVs for younger age groups compared to individuals over 64 years old.

Conclusions:

  • CHD ICD-9-CM codes show an acceptable PPV (86.54%) for identifying CHD cases when excluding specific codes.
  • Further evaluation and algorithm development are recommended to improve the accuracy of CHD identification across all ICD-9-CM code groups.
  • Enhanced algorithms could improve the reliability of CHD surveillance data derived from administrative and clinical databases.

Keywords:
birth defectscongenital heart defectsepidemiologysurveillancevalidation

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