Clinical codes combined with procedure codes increase diagnostic accuracy of Crohn’s disease in a US military health record

Abstract

Background and aimsPrevious examinations of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes to predict accuracy of diagnosis in inflammatory bowel disease have had limited chart review to confirm diagnosis. We aimed to evaluate using the ICD-9-CM for identifying Crohn’s disease (CD) in a large electronic health record (EHR) database.MethodsThis is a retrospective case-control study with a 3:1 allocation of EHRs of active duty service members diagnosed with CD from 1996 to 2012. Subjects were selected by having two ICD-9-CM codes for CD during the study period. Gastroenterologists reviewed each chart and confirmed the diagnosis of CD by analysing medication history and clinical, endoscopic, histological, and radiographic exams.Results300 cases of CD were selected; 14 cases were discarded due to lack of data, limiting our analysis to 284 subjects. Two diagnostic codes for CD had sensitivity, specificity, and positive predictive value (PPV) of 1.0, 0.53, and 0.69, respectively, for confirmed CD. If two encounters listing CD were with a gastroenterologist, the sensitivity, specificity, and PPV was 0.76, 0.81, and 0.80, respectively. If a colonoscopy was performed within 90 days of any three encounters with a CD code, the sensitivity, specificity, and PPV was 0.51, 0.94, and 0.89, respectively.ConclusionsThe poor PPV of ICD-9-CM codes in making the diagnosis of CD should be taken into consideration when interpreting results and when conducting research using such codes. Limiting these codes to those patients who have been given this diagnosis by a gastroenterologist, or to those who have had a colonoscopy near the time of diagnosis, increases the PPV.

Occurrence of inflammatory bowel disease in patients with chronic inflammatory skin diseases: a cohort study

“…IBD was defined as either a lower-endoscopic procedurecolonoscopy or flexible sigmoidoscopyfollowed by a diagnosis of IBD within 3 months, or hospitalization with a discharge diagnosis of IBD (positive predictive value of 81-88%). 17,18 Current guidelines report that IBD diagnosis requires endoscopic confirmation, which further informed our choice of outcome definition. 19,20 For each IBD outcome we also evaluated the component conditions -UC and CDseparately, using the same criteria of hospitalization or endoscopic confirmation.…”

“…We identified incident IBD events during all of the available follow‐up time. IBD was defined as either a lower‐endoscopic procedure – colonoscopy or flexible sigmoidoscopy – followed by a diagnosis of IBD within 3 months, or hospitalization with a discharge diagnosis of IBD (positive predictive value of 81–88%) 17,18 . Current guidelines report that IBD diagnosis requires endoscopic confirmation, which further informed our choice of outcome definition 19,20 .…”

Demographics and Seasonality of Retinal Detachment, Retinal Breaks, and Posterior Vitreous Detachment from the Intelligent Research in Sight Registry

“…We chose to use CPT codes because they are a more robust approach to identifying a procedure date or surgery date. 42,43 International Classification of Diseases codes can be reimplemented on multiple clinic visits (both before and after the true procedure date), making pinpointing an exact procedure date challenging. Inconsistencies in IRIS registry participation, such as an office-based center working out of a surgery center that is not an IRIS Registry participant, may have also introduced inconsistencies to the dataset.…”

Diagnostic accuracy of ICD code versus discharge summary-based query for endocarditis cohort identification

“…Using ICD in conjunction with a diagnostic procedure (or other defining data element) may be helpful in improving PPV and anchoring to the initial presentation. [ 17 , 24 ] However, the inclusion of echocardiogram did not significantly increase the PPV of our ICD-based algorithm, nor differentiate the rule-out cases.…”

“…Our ascertainment criteria were not only stringent regarding the fidelity of diagnosis but the timeliness since our hope was to use this cohort for longitudinal assessment of clinical outcomes such as mortality, which requires an accurate anchoring to time of presentation. Using ICD in conjunction with a diagnostic procedure (or other defining data element) may be helpful in improving PPV and anchoring to the initial presentation [17,24] . However, the inclusion of echocardiogram did not significantly increase the PPV of our ICD-based algorithm, nor differentiate the rule-out cases.…”