Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Reporting Methicillin-Resistant Staphylococcus aureus Infections at a Hospital in Illinois
- 1 May 2010
- journal article
- research article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 31 (5), 463-468
- https://doi.org/10.1086/651665
Abstract
Background.: States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA). Objective.: To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting. Methods.: We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections. Results.: We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed (P < .001). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections (P < .001). Conclusions.: Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections.Keywords
This publication has 10 references indexed in Scilit:
- Public health law for the collection and reporting of health care–associated infectionsAmerican Journal of Infection Control, 2008
- Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position PaperInfection Control & Hospital Epidemiology, 2008
- Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care–associated infectionsAmerican Journal of Infection Control, 2008
- Mandatory public reporting in the USA: an example to follow?Journal of Hospital Infection, 2007
- Comparisons of health care–associated infections identification using two mechanisms for public reportingAmerican Journal of Infection Control, 2007
- Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002Public Health Reports, 2007
- Administrative Data Fail to Accurately Identify Cases of Healthcare-Associated InfectionInfection Control & Hospital Epidemiology, 2006
- Community-associated Methicillin-resistantStaphylococcus aureusand Healthcare Risk FactorsEmerging Infectious Diseases, 2006
- Billing for inpatient hospital care.American Journal of Health-System Pharmacy, 2003
- Adverse Clinical and Economic Outcomes Attributable to Methicillin Resistance among Patients withStaphylococcus aureusSurgical Site InfectionClinical Infectious Diseases, 2003