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Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People.

Amy Board1, Alana Vivolo-Kantor2, Shin Y Kim1

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This summary is machine-generated.

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.

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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.