The Accuracy of ICD Codes

Identifying Physical Abuse in 4 Children's Hospitals

Anneka M. Hooft, Andrea G. Asnes, Nina Livingston, Stephanie Deutsch, Linda Theill Cahill, Joanne N. Wood, John M. Leventhal

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Abstract Objective To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. Methods We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. Results Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. Conclusions Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.

Original languageEnglish (US)
Article number683
Pages (from-to)444-450
Number of pages7
JournalAcademic Pediatrics
Volume15
Issue number4
DOIs
StatePublished - Jul 1 2015

Fingerprint

International Classification of Diseases
Child Abuse
Sensitivity and Specificity
Accidents
Confidence Intervals
Wounds and Injuries
Medical Records
Physical Abuse
Databases
Physicians

Keywords

  • abuse
  • epidemiology
  • ICD-9-CM codes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Hooft, A. M., Asnes, A. G., Livingston, N., Deutsch, S., Cahill, L. T., Wood, J. N., & Leventhal, J. M. (2015). The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals. Academic Pediatrics, 15(4), 444-450. [683]. https://doi.org/10.1016/j.acap.2015.01.008

The Accuracy of ICD Codes : Identifying Physical Abuse in 4 Children's Hospitals. / Hooft, Anneka M.; Asnes, Andrea G.; Livingston, Nina; Deutsch, Stephanie; Cahill, Linda Theill; Wood, Joanne N.; Leventhal, John M.

In: Academic Pediatrics, Vol. 15, No. 4, 683, 01.07.2015, p. 444-450.

Research output: Contribution to journalArticle

Hooft, AM, Asnes, AG, Livingston, N, Deutsch, S, Cahill, LT, Wood, JN & Leventhal, JM 2015, 'The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals', Academic Pediatrics, vol. 15, no. 4, 683, pp. 444-450. https://doi.org/10.1016/j.acap.2015.01.008
Hooft, Anneka M. ; Asnes, Andrea G. ; Livingston, Nina ; Deutsch, Stephanie ; Cahill, Linda Theill ; Wood, Joanne N. ; Leventhal, John M. / The Accuracy of ICD Codes : Identifying Physical Abuse in 4 Children's Hospitals. In: Academic Pediatrics. 2015 ; Vol. 15, No. 4. pp. 444-450.
@article{0d75e2eb369649d28d90340fe45823a8,
title = "The Accuracy of ICD Codes: Identifying Physical Abuse in 4 Children's Hospitals",
abstract = "Abstract Objective To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. Methods We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. Results Of 936 cases of suspected physical abuse, 65.8{\%} occurred in children <1 year of age. CAPs rated 32.7{\%} as abuse, 18.2{\%} as unknown cause, and 49.1{\%} as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5{\%} (95{\%} confidence interval 68.2, 78.4), and 92.4{\%} (95{\%} confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8{\%} to 83.8{\%} and specificity from 85.4{\%} to 100{\%}. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. Conclusions Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.",
keywords = "abuse, epidemiology, ICD-9-CM codes",
author = "Hooft, {Anneka M.} and Asnes, {Andrea G.} and Nina Livingston and Stephanie Deutsch and Cahill, {Linda Theill} and Wood, {Joanne N.} and Leventhal, {John M.}",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.acap.2015.01.008",
language = "English (US)",
volume = "15",
pages = "444--450",
journal = "Academic Pediatrics",
issn = "1876-2859",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - The Accuracy of ICD Codes

T2 - Identifying Physical Abuse in 4 Children's Hospitals

AU - Hooft, Anneka M.

AU - Asnes, Andrea G.

AU - Livingston, Nina

AU - Deutsch, Stephanie

AU - Cahill, Linda Theill

AU - Wood, Joanne N.

AU - Leventhal, John M.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Abstract Objective To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. Methods We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. Results Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. Conclusions Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.

AB - Abstract Objective To assess the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes in identifying cases of child physical abuse in 4 children's hospitals. Methods We included all children evaluated by a child abuse pediatrician (CAP) for suspicion of abuse at 4 children's hospitals from January 1, 2007, to December 31, 2010. Subjects included both patients judged to have injuries from abuse and those judged to have injuries from accidents or to have medical problems. The ICD-9-CM codes entered in the hospital discharge database for each child were compared to the decisions made by the CAPs on the likelihood of abuse. Sensitivity and specificity were calculated. Medical records for discordant cases were abstracted and reviewed to assess factors contributing to coding discrepancies. Results Of 936 cases of suspected physical abuse, 65.8% occurred in children <1 year of age. CAPs rated 32.7% as abuse, 18.2% as unknown cause, and 49.1% as accident/medical cause. Sensitivity and specificity of ICD-9-CM codes for abuse were 73.5% (95% confidence interval 68.2, 78.4), and 92.4% (95% confidence interval 90.0, 94.0), respectively. Among hospitals, sensitivity ranged from 53.8% to 83.8% and specificity from 85.4% to 100%. Analysis of discordant cases revealed variations in coding practices and physicians' notations among hospitals that contributed to differences in sensitivity and specificity of ICD-9-CM codes in child physical abuse. Conclusions Overall, the sensitivity and specificity of ICD-9-CM codes in identifying cases of child physical abuse were relatively low, suggesting both an under- and overcounting of abuse cases.

KW - abuse

KW - epidemiology

KW - ICD-9-CM codes

UR - http://www.scopus.com/inward/record.url?scp=84933496986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84933496986&partnerID=8YFLogxK

U2 - 10.1016/j.acap.2015.01.008

DO - 10.1016/j.acap.2015.01.008

M3 - Article

VL - 15

SP - 444

EP - 450

JO - Academic Pediatrics

JF - Academic Pediatrics

SN - 1876-2859

IS - 4

M1 - 683

ER -