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

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 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).

Associations Between Social Risk Factors and Surgical Site Infections After Colectomy and Abdominal Hysterectomy

“…14,15 Briefly, SSIs recorded during the first 30 days after surgical procedures were identified using ICD-9-CM diagnosis codes from encounters in the State Inpatient Databases and State Ambulatory Surgery Databases. 16 Prior work 17,18 in this area has suggested that use of these codes has sensitivity similar to that of routine clinical surveillance for detecting complex SSI, but a lower positive predictive value. We censored the observation period to avoid misclassification of SSIs after a subsequent surgery using the NHSN procedure list, as described elsewhere.…”

ICD-9-CM Coding for Multidrug Resistant Infection Correlates Poorly With Microbiologically Confirmed Multidrug Resistant Infection

“…1 Unfortunately, ICD-9-CM coding is subject to error and does not always reflect the true level of comorbid and acute illnesses. 2 Little research has been done to determine the accuracy of ICD-9-CM codes to identify multidrug-resistant organism (MDRO) infections.…”

“…To the Editor— The International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) coding system is often used to conduct surveillance for various infections 1 . Unfortunately, ICD-9-CM coding is subject to error and does not always reflect the true level of comorbid and acute illnesses 2 .…”

Incidência e fatores associados a complicações em feridas operatórias de mulheres mastectomizadas

“…Na literatura, observa-se que as principais complicações apresentadas pós-mastectomia são infecção 4,9,26 , hematoma 4,27 , seroma 4,5,9,[27][28][29] , deiscência 4,9,27 , necrose 4,27 , sangramento 9 e celulite 27 . O que corrobora com o estudo, o qual também inclui a epidermólise como complicação incidente no pós-operatório de mastectomia.…”