Use of ICD-9-CM coding for identifying antibiotic prescriptions during hospitalization: a Delphi consensus model

Area of Science:

• Health Services Research
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for combating antimicrobial resistance.
• Accurate identification of hospital admissions involving antimicrobial use is essential for effective ASPs.
• Existing methods for monitoring antimicrobial consumption may not be comprehensive.

Purpose of the Study:

• To develop and validate a comprehensive list of ICD-9-CM codes for identifying hospital admissions with probable antimicrobial prescriptions.
• To facilitate large-scale monitoring of antimicrobial drug consumption.
• To support the implementation and evaluation of antimicrobial stewardship strategies.

Main Methods:

• A Delphi consensus-seeking procedure was employed with a panel of experts.
• A comprehensive list of ICD-9-CM codes was systematically reviewed and validated.
• The validation process focused on codes indicative of antimicrobial prescribing.

Main Results:

• A total of 2967 ICD-9-CM codes were validated out of 16229 reviewed codes (18.28%).
• The validated codes demonstrated consensus among the expert panel for identifying relevant hospital admissions.
• The selected codes represent a significant proportion of potential antimicrobial prescribing indicators.

Conclusions:

• The validated list of ICD-9-CM codes provides a feasible tool for identifying hospital admissions where antimicrobials are likely prescribed.
• This validated code set can significantly enhance the capacity for large-scale monitoring of antimicrobial consumption.
• The findings support the integration of these codes into health information systems to bolster antimicrobial stewardship initiatives.