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Validation of ICD-9-CM Diagnosis Codes for Surgical Site Infection and Noninfectious Wound Complications after Mastectomy
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Dec 15 2016
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Source: Infect Control Hosp Epidemiol. 38(3):334-339.
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Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Description: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 ICD-9-CM diagnosis codes in administrative 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 for mastectomy with or without immediate breast reconstruction and were coded with 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 to identify 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 coding of 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, although the PPV varies 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).
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Pubmed ID:27974057
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Pubmed Central ID:PMC5490368
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