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Validity of ICD-9-CM Coding for Identifying Incident Methicillin-Resistant Staphylococcus aureus (MRSA) Infections: Is MRSA Infection Coded as a Chronic Disease?

Published online by Cambridge University Press:  02 January 2015

Marin L. Schweizer ,
Michael R. Eber ,
Ramanan Laxminarayan ,
Jon P. Furuno ,
Kyle J. Popovich ,
Bala Hota ,
Michael A. Rubin  and
Eli N. Perencevich
Marin L. Schweizer*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Michael R. Eber
Affiliation:
Center for Disease Dynamics, Economics, and Policy, Resources for the Future, Washington, DC
Ramanan Laxminarayan
Affiliation:
Center for Disease Dynamics, Economics, and Policy, Resources for the Future, Washington, DC
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Kyle J. Popovich
Affiliation:
Rush University Medical Center and Stroger Hospital of Cook County, Chicago, Illinois
Bala Hota
Affiliation:
Rush University Medical Center and Stroger Hospital of Cook County, Chicago, Illinois
Michael A. Rubin
Affiliation:
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City VA Medical Center, Iowa City, Iowa
*
Division of General Internal Medicine, Department of Internal Medicine, 200 Hawkins Drive, SE 620 GH, Iowa City, IA 52242-1081 ([email protected])
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Abstract

Background and Objective.

Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug-resistant microorganisms (V09) for identifying culture-proven MRSA infection.

Design.

Retrospective cohort study.

Methods.

All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The k statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.

Results.

There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%–34%) and positive predictive value of 31% (range, 22%–53%). The agreement between assignment of the V09 code and presence of MRSA infection had a k coefficient of 0.26 (95% confidence interval, 0.25–0.27).

Conclusions.

In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 148 - 154
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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