Does Clinical Evidence Support ICD-9-CM Diagnosis Coding of Complications
Bibliographic Data
| ID | 9101254 |
|---|---|
| Authors | Ellen P McCarthy (0000-0003-1705-6249, Beth Israel Deaconess Medical Center, corresponding author), Lisa I Iezzoni (0000-0002-1416-5039, corresponding author), Roger B Davis (0000-0003-3330-3123, corresponding author), R Heather Palmer, Michael Cahalane, Michael J Cahalane, Mary Beth Hamel (corresponding author), Kenneth J Mukamal (0000-0001-8450-6970, corresponding author), Kenneth Mukamal, Richard S Phillips (0000-0002-7281-7154, corresponding author), RUSSELL S PHILLIPS, Donald T Davies (corresponding author) |
| Year | 2000 |
| Volume | 38 |
| Issue | 8 |
| Pages | 868-876 |
| Publication date | 2000-08-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/00005650-200008000-00010 |
| PMID | 10929998 |
| OpenAlex | W2330666304 |
| Language | EN |
| Citations received | 20 |
| References cited | 23 |
BACKGROUND: Hospital discharge diagnoses, coded by use of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), increasingly determine reimbursement and support quality monitoring. Prior studies of coding validity have investigated whether coding guidelines were met, not whether the clinical condition was actually present. OBJECTIVE: To determine whether clinical evidence in medical records confirms selected ICD-9-CM discharge diagnoses coded by hospitals. RESEARCH DESIGN AND SUBJECTS: Retrospective record review of 485 randomly sampled 1994 hospitalizations of elderly Medicare beneficiaries in Califomia and Connecticut. MAIN OUTCOME MEASURE: Proportion of patients with specified ICD-9-CM codes representing potential complications who had clinical evidence confirming the coded condition. RESULTS: Clinical evidence supported most postoperative acute myocardial infarction diagnoses, but fewer than 60% of other diagnoses had confirmatory clinical evidence by explicit clinical criteria; 30% of medical and 19% of surgical patients lacked objective confirmatory evidence in the medical record. Across 11 surgical and 2 medical complications, objective clinical criteria or physicians' notes supported the coded diagnosis in >90% of patients for 2 complications, 80% to 90% of patients for 4 complications, 70% to <80% of patients for 5 complications, and <70% for 2 complications. For some complications (postoperative pneumonia, aspiration pneumonia, and hemorrhage or hematoma), a large fraction of patients had only a physician's note reporting the complication. CONCLUSIONS: Our findings raise questions about whether the clinical conditions represented by ICD-9-CM codes used by the Complications Screening Program were in fact always present. These findings highlight concerns about the clinical validity of using ICD-9-CM codes for quality monitoring
Current Procedural Terminology · Diagnosis code · Health care · ICD-10 · Intensive care medicine · Medical classification · Medical diagnosis · Medical record · MEDLINE · Pathology · Pneumonia · Population · Psychiatry · Reimbursement · Chronic Disease Management Strategies · Emergency Medicine · Healthcare cost, quality, practices · Internal Medicine · Medical Coding and Health Information · Medicine · Surgery
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| Unique citing works | 20 |
|---|---|
| Citations per year | 0,77 |
| Citation span | 2000 - 2018 (19) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 19 |