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White, R.H. et al.

Richard H. White, Martina Garcia, Banafsheh Sadeghi, Daniel J. Tancredi, Patricia Zrelak, Joanne Cuny, Pradeep Sama, Harriet Gammon, Stephen Schmaltz, Patrick S. Romano,

Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States.

OBJECTIVE: To determine the positive predictive value of International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) discharge codes for acute deep vein thrombosis or pulmonary embolism. MATERIALS AND METHODS: Retrospective review of 3456 cases hospitalized between 2005 and 2007 that had a discharge code for venous thromboembolism, using 3 sample populations: a single academic hospital, 33 University HealthSystem Consortium hospitals, and 35 community hospitals in a national Joint Commission study. Analysis was stratified by position of the code in the principal versus a secondary position. RESULTS: Among 1096 cases that had a thromboembolism code in the principal position the positive predictive value for any acute venous thrombosis was 95% (95%CI:93-97), whereas among 2360 cases that had a thromboembolism code in a secondary position the predictive value was lower, 75% (95%CI:71-80). The corresponding positive predictive values for lower extremity deep-vein thrombosis or pulmonary embolism were 91% (95%CI:86-95) and 50% (95%CI:41-58), respectively. More highly defined codes had higher predictive value. Among codes in a secondary position that were false positive, 22% (95%CI:16-27) had chronic/prior venous thrombosis, 15% (95%CI:10-19) had an upper extremity thrombosis, 6% (95%CI:4-8) had a superficial vein thrombosis, and 7% (95%CI:4-13) had no mention of any thrombosis. CONCLUSIONS: ICD-9-CM codes for venous thromboembolism had high predictive value when present in the principal position, and lower predictive value when in a secondary position. New thromboembolism codes that were added in 2009 that specify chronic thrombosis, upper extremity thrombosis and superficial venous thrombosis should reduce the frequency of false-positive thromboembolism codes.[1]

References

Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States. White, R.H., Garcia, M., Sadeghi, B., Tancredi, D.J., Zrelak, P., Cuny, J., Sama, P., Gammon, H., Schmaltz, S., Romano, P.S. Thromb. Res. (2010) [Pubmed]

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