Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke - Effect of modifier codes
Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke - Effect of modifier codes
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DOI：
10.1161/01.str.29.8.1602
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发表时间：
1998-08-01
期刊：
影响因子：
8.3
通讯作者：
Goldstein, LB
中科院分区：
文献类型：
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作者：
Goldstein, LB
背景和目的-出院ICD-9-CM（国际疾病分类，第9次修订，临床修改）代码已被用于识别急性卒中患者的流行病学，护理质量和成本研究。本研究的目的是确定修改代码是否提高了缺血性卒中的主要ICD-9-CM代码的准确性，以及特定代码如何反映卒中亚型诊断。方法：1995年5月至1997年6月期间从一家医院出院的所有患者的可用医院图表，ICD-9-CM代码为433 434例（脑动脉闭塞）或436例（急性但不明确的脑血管疾病）。初步出院诊断进行了验证，并在病历中提供的信息的基础上分配一个假定的中风亚型。结果图表可用于198例患者中的175例（88%）。其中，61%发生急性缺血性卒中（代码433，4%; 434，82%; 436，79%），其余患者患有其他疾病。在130名修改代码指示脑梗死的患者中，79%患有急性卒中;在45名修改代码指示没有脑梗死的患者中，7%患有急性卒中（灵敏度，0.97;特异性，0.60）。缺血性卒中病例比例最高的编码为434.11（脑动脉栓塞性闭塞伴梗死，85%）、434.91（未指明的脑前动脉闭塞伴梗死，82%）和436（79%），综合敏感性为0.81，特异性为0.90。经审查，73%代码为434.11的患者发生栓塞性卒中，47%代码为436的患者有明确的卒中原因。代码为434.91的患者中，39%的中风原因不明，25%的“腔隙性”，17%的动脉粥样硬化血栓形成，和15%embolization.Conclusions，尽管使用修改代码，15%至20%的患者与指定的主要ICD-9-CM代码有条件以外的急性缺血性中风。虽然使用修改代码后急性卒中患者比例从61%增加至79%，但如果排除代码为433的患者，则包含修改代码对编码准确性没有明显影响。假定缺血性卒中亚型的分配尤其不准确。
Background and Purpose-Discharge ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes have been used to identify patients with acute stroke for epidemiological, quality of care, and cost studies. The aim of this study was to determine if the accuracy of the primary ICD-9-CM codes for ischemic stroke is improved by modifier codes and how specific codes reflect stroke subtype diagnoses.Methods-Available hospital charts for all patients discharged from a single hospital between May 1995 and June 1997 with ICD-9-CM codes 433 (occlusion and stenosis of precerebral arteries), 434 (occlusion of cerebral arteries), or 436 (acute but ill-defined cerebrovascular disease) listed in the first position were reviewed. The primary discharge diagnosis was verified, and a presumed stroke subtype was assigned on the basis of information provided in the medical record.Results-Charts were available for 175 of the 198 identified patients (88%). Of these, 61% had an acute ischemic stroke (code 433, 4%; 434, 82%; 436, 79%) with the remaining patients having other conditions. Of the 130 patients with a modifier code indicating cerebral infarction, 79% had an acute stroke; of the 45 patients with a modifier code indicating an absence of cerebral infarction, 7% had acute stroke (sensitivity, 0.97; specificity, 0.60). The codes with the highest proportions of ischemic stroke cases were 434.11 (embolic occlusion of cerebral arteries with infarction, 85%), 434.91 (unspecified occlusion of precerebral arteries with infarction, 82%), and 436 (79%), with a combined sensitivity of 0.81 and specificity of 0.90. On review, 73% of patients with code 434.11 had embolic strokes, and 47% of those with code 436 had an identified stroke cause. Of patients with code 434.91, 39% had stroke of uncertain cause, 25% "lacunar," 17% atherothrombosis, and 15% embolism.Conclusions-Despite the use of modifier codes, 15% to 20% of patients with the indicated primary ICD-9-CM codes have conditions other than acute ischemic stroke. Although the proportion of patients with acute stroke increased from 61% to 79% with the use of modifier codes, the inclusion of modifier codes did not have an appreciable effect on the accuracy of the coding if patients with code 433 are excluded. Assignment of presumed ischemic stroke subtype is particularly inaccurate.