Lane, Peter A

Snyder, Angela

Theodore, Rodney

Zhou, Mei

English

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Materials Georgia Health Policy Center 8-26-2016 Accuracy of ICD-9 Coding for Sickle Cell Disease (SCD) in Children and Adolescents: Results from the Georgia (GA) RuSH Surveillance Project Peter A. Lane Rodney Theodore Mei Zhou Angela Snyder Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials Recommended Citation Lane, Peter A.; Theodore, Rodney; Zhou, Mei; and Snyder, Angela, "Accuracy of ICD-9 Coding for Sickle Cell Disease (SCD) in Children and Adolescents: Results from the Georgia (GA) RuSH Surveillance Project" (2016). GHPC Materials. 135. https://scholarworks.gsu.edu/ghpc_materials/135 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. ANDREW  YOUNG SCHOOL O F  P O L I C Y  S T U D I E SRESEARCH OBJECTIVETo study the accuracy of using ICD-9 codes within administrative claims data to identify individuals with Sickle Cell Disease (SCD).Accuracy of ICD-9 Coding for Sickle Cell Disease (SCD) in Children and Adolescents: Results from the Georgia (GA) RuSH Surveillance Project Peter A Lane MD, Rodney Theodore MPH, Mei Zhou MS, Angela Snyder PhDFor more information, please contact the Georgia Health Policy Center at 404.413.0314 or visit us online at www.ghpc.gsu.eduSTUDY DESIGNRetrospective study to evaluate the accuracy of the Registry and Surveillance for Hemoglobinopathies (RuSH) case definition in identifying true cases of SCD in administrative datasets.  Probable cases required identification of ≥ 2 encounters with a SCD ICD-9 code (282.60-282.69; 282.41-282.42) plus ≥ 1 encounter with an ICD-9 or CPT code from a predetermined list of SCD-associated treatments, procedures, and complications (SCD-TPC).POPULATION STUDIEDA total of 1,998 children and adolescents with ≥ 1 encounter with a SCD ICD-9 code in three administrative datasets: Georgia Medicaid, CHIP, and State Health Benefit Plan claims data from 2004-2008 who were seen at least once at a CHOA facility and had medical records available for review.PRINCIPAL FINDINGSSCD was confirmed in 1,763 (88.2%), excluded in 196 (9.8%), and indeterminate in 39 (2.0%) of the 1,998 children.CONCLUSIONUse of administrative claims data to identify children and adolescents with SCD based on ICD-9 coding can be useful to health services researchers, but it has some limitations depending on the research question. Accuracy of identification correlated directly with the number of SCD-coded encounters and indirectly with the length of the surveillance period. The addition of ≥ 1 encounter with SCD-TPC to a case definition of ≥ 2 encounters with SCD ICD-9 codes minimally improved specificity but resulted in a large number of missed cases, more than the simpler definition of ≥ 3 SCD-coded encounters.IMPLICATIONS FOR POLICY OR PRACTICEHealth services and outcomes research in SCD has been limited by inadequate population-based surveillance and reliance on ICD-9 codes to identify individuals with SCD. This study supports an administrative case definition that includes 3 or more separate ICD-9 codes in order to identify SCD with a high degree of accuracy and suggests it can be useful to assess quality of care.  However, using administrative data, by design, excludes individuals who have less health care utilization and are therefore less costly.  Those limitations must be weighed against the benefits of using the data in future health services research.Cases identified in administrative data were then compared to laboratory and clinical chart review data from Children’s Healthcare of Atlanta (CHOA) to report on the accuracy of this case definition. Specific objectives were to evaluate accuracy in terms of 1) the number of SCD-coded encounters for each individual, 2) the addition of SCD-TPC to the case definition, and 3) the length of the surveillance period (1 versus 5 years of data). Cases with inadequate clinical data to confirm or exclude SCD were categorized as indeterminate.The likelihood of having SCD significantly increased with an increasing number of SCD ICD-9 codes during both time periods. The 1-year period had better accuracy, but more missed cases. For the 5-year surveillance period, the accuracy of ≥ 2 SCD ICD-coded encounters (93.7%) increased to (97.0%) with the addition of ≥ 1 encounter with SCD-TPC, but the number of missed cases increased from 28 (1.6%) to 251 (14.2%). Table 1. SCD-associated treatments, procedures, and complications added to the RuSH case definition SCD-associated treatments SCD-associated  compl icat ionsHydroxyurea Chronic Renal failure/ProteinuriaParenteral analgesics (Morphine, meperidine, hydromorphone, ketorolac, butorphanol) Pneumonia, acute chest syndromeIron Chelators (deferasirox, deferoxamine) Pulmonary hypertensionErythropoietin Stroke (ischemic or hemorrhagic), TIA, seizuresFolic acid Intracranial bleedingPriapismIron overloadSCD-associated procedures Gallstones/cholelithiasis, cholecystitisRed cell transfusion Avascular necrosisRed cell exchange Retinal diseaseSplenectomy Splenomegaly, splenic  sequestration,  hyper-splenismCholecystectomy Leg ulcersTranscranial Doppler DactylitisOsteomyelitisTable 2. Relationship between number of encounters with SCD ICD-9 codes and SCD status determined by review of medical records for 5 year (2004-2008) versus 1 year (2008) surveillance periodSurveillance period (yr)SCD ICD-9 codes Patients SCD conf i rmed SCD excluded Indeterminate P-va lue*5 ≥ 1 1,998 1,763 (88.2%) 196 (9.8%) 39 (2.0%)<0.011 ≥ 1 1,454 1,386 (95.3%) 57 (3.7%) 11 (0.8%)5 ≥ 2 1,851 1,735 (93.7%) 96 (5.2%) 20 (1.1%)<0.011 ≥ 2 1,373 1,333 (97.1%) 33 (2.4%) 7 (0.5%)5 ≥ 3 1,746 1,693 (97.0%) 46 (2.6%) 7 (0.4%)<0.011 ≥ 3 1,248 1,231 (98.6%) 14 (1.1%) 3 (0.2%)Table 3. Effect of number of SCD ICD-9 codes and inclusion of ICD-9 and CPT codes for SCD-associated treatments, procedures, and complication to RuSH surveillance case definition (2004-2008)Case Definition Pat ients (n )SCD confirmedSCD cases missed≥ 1 SCD ICD-9 code 1,998 1,763 (88.2%) 0≥ 2 SCD ICD-9 codes 1,851 1,735 (93.7%) 28 (1.6%)≥ 2 SCD ICD-9 codes & ≥ 1 ICD-9/CPT code for SCD TPC1,558 1,512 (97.0%) 251 (14.2%)≥ 3 SCD ICD-9 codes 1,746 1,693 (97.0%) 70 (4.0%)*P-values calculated by chi-square tests.  P-value tests whether the proportion of those confirmed to have SCD using 5 years of data differs significantly from the proportion of those confirmed to have SCD using 1 year of data (i.e. compares 88.2% to 95.3%).This work was supported by Cooperative Agreement Numbers U50DD00582 and U50DD001010, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Accuracy of ICD-9 Coding for Sickle Cell Disease (SCD) in Children and Adolescents: Results from the Georgia (GA) RuSH Surveillance Project

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Accuracy of ICD-9 Coding for Sickle Cell Disease (SCD) in Children and Adolescents: Results from the Georgia (GA) RuSH Surveillance Project

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