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Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People
Amy Board1, Alana Vivolo-Kantor2, Shin Y Kim1
1Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
ICD-9/10-CM codes have low accuracy for identifying drug overdoses in pregnant individuals with opioid use disorder. High specificity and negative predictive value were observed, but sensitivity and positive predictive value were low.
Area of Science:
- Perinatal Health
- Public Health Surveillance
- Medical Informatics
Background:
- Rising perinatal drug overdose rates necessitate improved monitoring strategies.
- Accurate identification of overdose events during pregnancy and postpartum is critical.
- Medication for opioid use disorder (MOUD) is a key intervention for pregnant individuals.
Purpose of the Study:
- To evaluate the accuracy of ICD-9/10-CM codes for detecting drug overdose events in pregnant individuals receiving MOUD.
- To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these codes.
- To assess code performance during pregnancy and postpartum periods.
Main Methods:
- Analysis of electronic health records (EHR) for 3,911 pregnancies with MOUD and known outcomes (2014-2021).
- Comparison of ICD-9/10-CM codes against abstracted EHR data for drug overdose events.
- Utilized CDC drug overdose case definitions for categorization.
- Analyses conducted between May 2023 and May 2024.
Main Results:
- During pregnancy, ICD-9/10-CM code sensitivity for overdose was 32.7% (NPV 99.0%, specificity 98.5%, PPV 23.4%).
- Postpartum, code sensitivity was 30.9% (NPV 98.8%, specificity 98.4%, PPV 25.9%).
- Low sensitivity and PPV indicate undercounting of overdose events using these codes.
Conclusions:
- ICD-9/10-CM codes demonstrate low sensitivity and PPV for identifying perinatal drug overdoses in individuals with MOUD.
- High specificity and NPV suggest codes are reliable for ruling out overdose when absent.
- Integrating additional EHR data and external sources is recommended for comprehensive overdose surveillance.
Introduction:
As perinatal drug overdoses continue to rise, reliable approaches are needed to monitor overdose trends during pregnancy and postpartum. This analysis aimed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-9/10-CM codes for drug overdose events among people in the MATernaL and Infant clinical NetworK (MAT-LINK) with medication for opioid use disorder during pregnancy.
Methods:
People included in this analysis had electronic health record documentation of medication for opioid use disorder and a known pregnancy outcome from January 1, 2014, through August 31, 2021. Data were analyzed during pregnancy through 1 year postpartum. The Centers for Disease Control and Prevention's drug overdose case definitions were used to categorize overdose based on ICD-9/10-CM codes. These codes were compared to abstracted electronic health record data of any drug overdose. Analyses were conducted between May 2023 and May 2024.
Results:
Among 3,911 pregnancies with electronic health record-documented medication for opioid use disorder, the sensitivity of ICD-9/10-CM codes for capturing drug overdose during pregnancy was 32.7%, while specificity was 98.5%, positive predictive value was 23.4%, and negative predictive value was 99.0%. The sensitivity of ICD-9/10-CM codes for capturing drug overdose postpartum was 30.9%, while specificity was 98.4%, positive predictive value was 25.9%, and negative predictive value was 98.8%.
Conclusions:
The sensitivity and positive predictive value of ICD-9/10-CM codes for capturing drug overdose compared with abstracted electronic health record data during the perinatal period was low in this cohort of people with medication for opioid use disorder during pregnancy, though the specificity and negative predictive value were high. Incorporating other data from electronic health records and outside the healthcare system might provide more comprehensive insights on nonfatal drug overdose in this population.
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