Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care–associated infections

Use of Medicare Diagnosis and Procedure Codes to Improve Detection of Surgical Site Infections following Hip Arthroplasty, Knee Arthroplasty, and Vascular Surgery

“…It is important to note, however, that this strategy is associated with lower positive predictive values in this and other studies. [16][17][18][19] In fact, the low positive predictive value of diagnosis and procedure codes has been used as an argument against the use of administrative data for SSI surveillance. 18,19 Nevertheless, in practicality, this approach translates to a more efficient chart reviewed to confirmed SSI case ratio and a higher capture of SSI compared with traditional surveillance.…”

“…[16][17][18][19] In fact, the low positive predictive value of diagnosis and procedure codes has been used as an argument against the use of administrative data for SSI surveillance. 18,19 Nevertheless, in practicality, this approach translates to a more efficient chart reviewed to confirmed SSI case ratio and a higher capture of SSI compared with traditional surveillance. While we found that more restricted code lists performed better, it was important to assess code lists that would not be affected by intentional use of alternative codes and thus would provide a sustainable method for SSI surveillance.…”

Can Additional Information Be Obtained from Claims Data to Support Surgical Site Infection Diagnosis Codes?

“…Some authors have concluded that billing and claims data cannot be reliably used for SSI surveillance. 4,9,10 We found that 94.3% of patients identified as having an SSI by our rigorous claims algorithm also received clinically expected treatment for infection; a more conservative PPV estimate excluding culture was still very high, at 89.5%. While we could not confirm the SSIs with medical chart review, our results suggest that the claims algorithm we used to identify SSIs has very good PPV.…”

“…Studies that used specific SSI ICD-9-CM diagnosis codes (eg, 998.5, 998.51, and 998.59) 1 " 3 were more likely to report a higher PPV than studies using a larger range of diagnosis codes including ones less specific for SSI. 4 ' 9 ' 10 We also used available information to distinguish preexisting and incident infections and censored at the time of any subsequent procedures. This censoring reduced the likelihood of attributing an SSI after a subsequent surgery to the index ACL reconstruction, which has been reported previously as a source of misclassification bias when using administrative data.…”

“…In the indicate infection. 1 " 10 Anterior cruciate ligament (ACL) reabsence of a gold standard such as medical chart review, we construction is a surgical procedure for which there has been used clinically expected treatments available in the adminno validation of the ICD-9-CM diagnosis codes to identify istrative claims-specifically, antibiotic utilization, use of misubsequent SSIs.…”