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Validation of ICD-9-CM Diagnosis Codes for Surgical Site Infection and Noninfectious Wound Complications After Mastectomy

Published online by Cambridge University Press:  15 December 2016

Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Kelly E. Ball
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Anna E. Wallace
Affiliation:
HealthCore, Inc., Wilmington, Delaware
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Margaret A. Olsen, PhD, MPH, Professor of Medicine and Surgery, Washington University School of Medicine, Campus Box 8051, 660 S. Euclid Ave., St. Louis, MO 63110 (molsen@wustl.edu).

Abstract

BACKGROUND

Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.

OBJECTIVES

To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.

METHODS

We reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.

RESULTS

The PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).

CONCLUSIONS

Our results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).

Infect Control Hosp Epidemiol 2017;38:334–339

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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