What question did this study set out to answer?

Determine whether modifier codes improve the diagnostic accuracy of primary ICD-9-CM codes for acute ischemic stroke and assess how accurately specific codes identify stroke subtypes.

August 1, 1998Stroke

Accuracy of ICD-9-CM Coding for the Identification of Patients With Acute Ischemic Stroke

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Authors

LGLarry B. GoldsteinCross-Cutting Cardiology

Discussion

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Implication

Chart review reveals 15% to 20% misclassification rates in ICD-9-CM stroke codes among hospitalized patients, highlighting inaccuracies in administrative data for stroke subtype identification.

Key Points

Determine whether modifier codes improve the diagnostic accuracy of primary ICD-9-CM codes for acute ischemic stroke and assess how accurately specific codes identify stroke subtypes.
Reviewed hospital charts for 175 of 198 eligible patients (88%) discharged from a single hospital between May 1995 and June 1997.
Included patients with primary discharge ICD-9-CM codes 433 (precerebral occlusion/stenosis), 434 (cerebral occlusion), or 436 (acute ill-defined cerebrovascular disease).
Verified primary discharge diagnoses and assigned stroke subtypes based on medical record data.
Acute ischemic stroke was confirmed in 61% of all reviewed cases (code 433: 4%, code 434: 82%, code 436: 79%), rising to 79% among the 130 patients with a modifier code for cerebral infarction (sensitivity 0.97, specificity 0.60).
Codes 434.11 (85%), 434.91 (82%), and 436 (79%) yielded the highest proportion of confirmed ischemic stroke cases, with a combined sensitivity of 0.81 and specificity of 0.90.
Stroke subtype classification was inaccurate: only 73% of patients with code 434.11 had embolic strokes, while code 434.91 comprised strokes of uncertain cause (39%), lacunar (25%), atherothrombosis (17%), and embolism (15%).

Cite This Study

Larry B. Goldstein (1998) studied this question.

synapsesocial.com/papers/6a1034f392676d5461fdb6bc https://doi.org/10.1161/01.str.29.8.1602

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Implication

Chart review reveals 15% to 20% misclassification rates in ICD-9-CM stroke codes among hospitalized patients, highlighting inaccuracies in administrative data for stroke subtype identification.

Accuracy of ICD-9-CM Coding for the Identification of Patients With Acute Ischemic Stroke

Discussion

Member takes

Implication

Key Points

Cite This Study

Accuracy of ICD-9-CM Coding for the Identification of Patients With Acute Ischemic Stroke

Discussion

Member takes

Implication

Key Points

Cite This Study

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