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Improved Coding of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Administrative Data (AHRQ Patient Safety Indicator 12) After Introduction of New ICD-9-CM Diagnosis Codes

Sadeghi, Banafsheh MD, PhD*; White, Richard H. MD, FACP*; Maynard, Gregory MD, MSc, SFHM; Zrelak, Patricia PhD, RN, CNRN, NEA-BC; Strater, Amy MPH, MBA§; Hensley, Laurie MHA§; Cerese, Julie RN, MSN§; Romano, Patrick MD, MPH*,‡

doi: 10.1097/MLR.0b013e318287d59e
Applied Methods

Background: Symptomatic venous thromboembolism is a common postoperative complication. The Agency for Healthcare Research and Quality (AHRQ) has developed a Patient Safety Indicator 12 to assist hospitals, payers, and other stakeholders to identify patients who experienced this complication.

Objectives: To determine whether newly created and recently redefined ICD-9-CM codes improved the criterion validity of Patient Safety Indicator 12, based on new samples of records dated after October 2009.

Research Design, Subjects, Measures: Two sources of data were used: (1) UHC retrospective case-control study of risk factors for acute symptomatic venous thromboembolism occurring within 90 days after total knee arthroplasty in teaching hospitals; (2) chart abstraction data by volunteer hospitals participating in the Validation Pilot Project of the AHRQ.

Results: In the UHC sample, the positive predictive value (PPV) was 99% (125/126) and the negative predictive value was 99.4% (460/463). In the AHRQ sample, the overall PPV was 81% (126/156).

Conclusions: The PPV based on both samples shows substantial improvement compared with the previously reported PPVs of 43%–48%, suggesting that changes in ICD-9-CM code architecture and better coding guidance can improve the usefulness of coded data.

Supplemental Digital Content is available in the text.

*Department of Medicine, Center for Healthcare Policy and Research, UC Davis School of Medicine, Sacramento

Center for Innovation and Improvement Science, University of California, San Diego

Center for Healthcare Policy and Research, University of California-Davis, Sacramento, CA

§UHC, Chicago, IL

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The authors declare no conflict of interest.

Reprints: Banafsheh Sadeghi, MD, PhD, Department of Medicine, UC Davis School of Medicine, Suite 2400, PSSB, 4150V Street, Sacramento, CA 95817. E-mail:

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