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Validity of ICD-9-CM Coding for Identifying Incident Methicillin-Resistant Staphylococcus aureus (MRSA) Infections: Is MRSA Infection Coded as a Chronic Disease?

Published online by Cambridge University Press:  02 January 2015

Marin L. Schweizer*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Michael R. Eber
Affiliation:
Center for Disease Dynamics, Economics, and Policy, Resources for the Future, Washington, DC
Ramanan Laxminarayan
Affiliation:
Center for Disease Dynamics, Economics, and Policy, Resources for the Future, Washington, DC
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Kyle J. Popovich
Affiliation:
Rush University Medical Center and Stroger Hospital of Cook County, Chicago, Illinois
Bala Hota
Affiliation:
Rush University Medical Center and Stroger Hospital of Cook County, Chicago, Illinois
Michael A. Rubin
Affiliation:
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City VA Medical Center, Iowa City, Iowa
*
Division of General Internal Medicine, Department of Internal Medicine, 200 Hawkins Drive, SE 620 GH, Iowa City, IA 52242-1081 (marin-schweizer@uiowa.edu)

Abstract

Background and Objective.

Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug-resistant microorganisms (V09) for identifying culture-proven MRSA infection.

Design.

Retrospective cohort study.

Methods.

All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The k statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.

Results.

There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%–34%) and positive predictive value of 31% (range, 22%–53%). The agreement between assignment of the V09 code and presence of MRSA infection had a k coefficient of 0.26 (95% confidence interval, 0.25–0.27).

Conclusions.

In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1. Noskin, GA, Rubin, RJ, Schentag, JJ, et al. The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample database. Arch Intern Med 2005;165(15):17561761.Google Scholar
2. Zilberberg, MD, Shorr, AF, Kollef, MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005. Emerg Infect Dis 2008;14(11):17561758.Google Scholar
3. Gerber, JS, Coffin, SE, Smathers, SA, Zaoutis, TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clin Infect Dis 2009;49(1):6571.Google Scholar
4. Byrd, KK, Holman, RC, Bruce, MG, et al. Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native population. Clin Infect Dis 2009;49(7):10091015.Google Scholar
5. Infections with methicillin-resistant Staphylococcus aureus (MRSA) in US hospitals, 1993-2005. HCUP Statistical Brief 35. Rockville, MD: Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb35.pdf. Accessed December 4, 2010.Google Scholar
6. OSHPD health facts: Methicillin-resistant Staphylococcus aureus infections in California hospital patients, 1999 to 2007. http://www.oshpd.ca.gov/HID/Products/Health_Facts/HealthFacts_MRSA_WEB.pdf. Accessed December 4, 2010.Google Scholar
7. Klompas, M, Yokoe, DS. Automated surveillance of health care-associated infections. Clin Infect Dis 2009;48(9):12681275.Google Scholar
8. Borlawsky, T, Hota, B, Lin, MY, et al. Development of a reference information model and knowledgebase for electronic bloodstream infection detection. AMIA Annu Symp Proc 2008:5660.Google Scholar
9. Bolon, MK, Hooper, D, Stevenson, KB, et al. Improved surveillance for surgical site infections after orthopedic implantation procedures: extending applications for automated data. Clin Infect Dis 2009;48(9):12231229.Google Scholar
10. Ollendorf, DA, Fendrick, AM, Massey, K, Williams, GR, Oster, G. Is sepsis accurately coded on hospital bills? Value Health 2002;5(2):7981.CrossRefGoogle ScholarPubMed
11. Stevenson, KB, Khan, Y, Dickman, J, et al. Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care-associated infections. Am I Infect Control 2008;36(3):155164.CrossRefGoogle ScholarPubMed
12. Sherman, ER, Heydon, KH, St John, KH, et al. Administrative data fail to accurately identify cases of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27(4):332337.Google Scholar
13. Moro, ML, Morsillo, F. Can hospital discharge diagnoses be used for surveillance of surgical-site infections? J Hosp Infect 2004;56(3):239241.Google Scholar
14. Wright, SB, Huskins, WC, Dokholyan, RS, Goldmann, DA, Platt, R. Administrative databases provide inaccurate data for surveillance of long-term central venous catheter-associated infections. Infect Control Hosp Epidemiol 2003;24(12):946949.CrossRefGoogle ScholarPubMed
15. Aronsky, D, Haug, PJ, Lagor, C, Dean, NC. Accuracy of administrative data for identifying patients with pneumonia. Am J Med Qual 2005;20(6):319328.Google Scholar
16. Martin, GS, Mannino, DM, Eaton, S, Moss, M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348(16):15461554.Google Scholar
17. Madsen, KM, Schonheyder, HC, Kristensen, B, Nielsen, GL, Sor-ensen, HT. Can hospital discharge diagnosis be used for surveillance of bacteremia? A data quality study of a Danish hospital discharge registry. Infect Control Hosp Epidemiol 1998;19(3):175180.Google Scholar
18. Schmiedeskamp, M, Harpe, S, Polk, R, Oinonen, M, Pakyz, A. Use of International Classification of Diseases, Ninth Revision, clinical modification codes and medication use data to identify nosocomial Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30(11):10701076.Google Scholar
19. Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135(6):10101013.Google Scholar
20. Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31(3):262268.CrossRefGoogle ScholarPubMed
21. Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12(10):15761579.Google Scholar
22. Schaefer, MK, Ellingson, K, Conover, C, et al. Evaluation of International Classification of Diseases, Ninth revision, clinical modification codes for reporting methicillin-resistant Staphylococcus aureus infections at a hospital in Illinois. Infect Control Hosp Epidemiol 2010;31(5):463468.Google Scholar
23. Wisniewski, MF, Kieszkowski, P, Zagorski, BM, Trick, WE, Sommers, M, Weinstein, RA. Development of a clinical data warehouse for hospital infection control. J Am Med Inform Assoc 2003;10(5):454462.Google Scholar
24. Osih, RB, McGregor, JC, Rich, SE, et al. Impact of empiric antibiotic therapy on outcomes in patients with Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother 2007;51(3):839844.Google Scholar
25. Furano, JP, Harris, AD, Wright, MO, et al. Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28(6):666670.Google Scholar
26. McGregor, JC, Perencevich, EN, Furano, JP, et al. Comorbidity risk-adjustment measures were developed and validated for studies of antibiotic-resistant infections. J Clin Epidemiol 2006;59(12):12661273.Google Scholar
27. Furuno, JP, Perencevich, EN, Johnson, JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant entero-cocci co-colonization. Emerg Infect Dis 2005;11(10):15391544.Google Scholar
28. McGregor, JC, Kim, PW, Perencevich, EN, et al. Utility of the chronic disease score and Charlson comorbidity index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005;161(5):483491.Google Scholar
29. Miller, RR 3rd, Markewitz, BA, Rolfs, RT, et al. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection. Chest 2010;137(4):752758.Google Scholar
30. Gundlapalli, AV, Tang, H, Tonnierre, C, et al. Validity of electronic medical record-based rules for the early detection of meningitis and encephalitis. AMIA Annu Symp Proc 2007;11:299303.Google Scholar
31. Erbay, A, Ergönül, O, Stoddard, GJ, Samore, MH. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis 2006;10(5):396400.CrossRefGoogle ScholarPubMed
32. Lin, MY, Weinstein, RA, Hota, B. Delay of active antimicrobial therapy and mortality among patients with bacteremia: impact of severe neutropenia. Antimicrob Agents Chemother 2008;52(9):31883194.CrossRefGoogle ScholarPubMed
33. Popovich, K, Hota, B, Rice, T, Aroutcheva, A, Weinstein, RA. Phe-notypic prediction rale for community-associated methicillin-resistant staphylococcus aureus. J Clin Microbiol 2007;45(7):22932295.Google Scholar
34. Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46(6):787794.CrossRefGoogle ScholarPubMed
35. Harris, AD, Furuno, JP, Roghmann, M, et al. Targeted surveillance of MRSA and its potential use to guide empiric antibiotic therapy. Antimicrob Agents Chemother 2010;54(8):31433148.Google Scholar
36. Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159174.Google Scholar
37. Jhung, MA, Banerjee, SN. Administrative coding data and health care-associated infections. Clin Infect Dis 2009;49(6):949955.Google Scholar
38. Hacek, DM, Paule, SM, Thomson, RB Jr, Robicsek, A, Peterson, LR. Implementation of a universal admission surveillance and decolonization program for methicillin-resistant Staphylococcus aureus (MRSA) reduces the number of MRSA and total number of S. aureus isolates reported by the clinical laboratory. J Clin Microbiol 2009;47(11):37493752.Google Scholar
39. Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409418.Google Scholar
40. Department of Veterans Affairs. Methicillin-resistant Staphylococcus aureus (MRSA) prevention initiative. February 3, 2010. http://wwwl.va.gov/vhapublications/ViewPublication.aspFpub_ID = 2163. Accessed December 6, 2010.Google Scholar
41. National Center for Health Statistics. ICD-9-CM index to diseases addenda (FY09). October 1, 2008. http://www.cdc.gov/nchs/data/icd9/icdidx09add.pdf. Accessed December 6, 2010.Google Scholar
42. Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007;13(12):18401846.Google Scholar
43. Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11(6):868872.Google Scholar
44. Jones, ME, Draghi, DC, Thornsberry, C, Karlowsky, JA, Sahm, DF, Wenzel, RP. Emerging resistance among bacterial pathogens in the intensive care unit–a European and North American surveillance study (2000-2002). Ann Clin Microbiol Antimicrob 2004;3:14.Google Scholar
45. Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs). Feb 2, 2010. http://www.cdc.gov/abcs/index.html. Accessed December 6, 2010.Google Scholar
46. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.Google Scholar