Cited by 212Medical Coding and Health InformationLiver Disease and TransplantationElectronic Health Records Systems

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Use of Administrative Claims Data for Identifying Patients with Cirrhosis

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Nehra, Mahendra S., Ma, Ying, Clark, Christopher, Amarasingham, Ruben, Rockey, Don C., Singal, Amit G.·2013·Journal of Clinical Gastroenterology

DOI 10.1097/mcg.0b013e3182688d2fPMC PMC3556340

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Abstract

BACKGROUND: Administrative data are used in clinical research, but the validity of ICD-9 codes to identify cirrhotic patients has not been well established. GOALS: To determine the diagnostic accuracy of ICD-9 codes for cirrhosis in clinical practice. STUDY: We conducted a retrospective cohort study of patients from a safety-net hospital between 2008 and 2011. Patients were initially identified using ICD-9 codes for cirrhosis or a resultant complication. The gold-standard for diagnosis of cirrhosis was histology and/or imaging based on medical record review. Sensitivity, specificity, positive predictive values, and negative predictive values for each ICD-9 code were calculated. Diagnostic accuracy was assessed by the c-statistic using receiver operator characteristic curve analysis. RESULTS: We identified 2893 patients with an ICD-9 code for cirrhosis, of whom 50.2% had 1 ICD-9 code, 20.3% had 2 different codes, and 29.5% had 3 or more codes. Cirrhosis was confirmed in 44.0% of patients with 1 ICD-9 code, 82.6% with 2 codes, and 95.7% of those with at least 3 codes. Ascites had a significantly lower positive predictive values for cirrhosis than other ICD-9 codes (P<0.001). The optimal combination of ICD-9 codes to identify cirrhotic patients included all codes except that of ascites, with a c-statistic of 0.71 in our derivation cohort. The sensitivity of this combination was confirmed to be 98% in a validation cohort of 285 patients with known cirrhosis. CONCLUSIONS: Administrative data can identify patients with cirrhosis with high accuracy, although ascites has a significantly lower positive predictive value than other ICD-9 codes.

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Authors: Nehra, M. S., Ma, Y., Clark, C., Amarasingham, R., Rockey, D. C., & Singal, A. G.
Affiliations: Parkland Health & Hospital System (US)
Corresponding author: Nehra, Mahendra S.
Rockey, Don C.
Singal, Amit G.
ORCID: Ma, Ying
Rockey, Don C.
Singal, Amit G.
Venue: Journal of Clinical Gastroenterology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-05
Volume: 47
Issue: 5
Pages: e50-e54
ISSN: 0192-0790 (ISSN-L)
DOI: 10.1097/mcg.0b013e3182688d2f
PMC: PMC3556340
OpenAlex: W2061784149
Cited by: 211
References: 15
Citations by year: 2026: 11 · 2025: 17 · 2024: 17 · 2023: 21 · 2022: 13 · 2021: 22 · 2020: 31 · 2019: 20 · 2018: 17 · 2017: 8 · 2016: 16 · 2015: 9 · 2014: 5 · 2013: 3
FWCI: 9.33
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Journal of Clinical Gastroenterology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (2kl2tr000453-06, UL1TR000451)
National Center for Research Resources (KL2RR024983)
National Center for Advancing Translational Sciences (KL2TR000453.)
Topics: Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords: liver cirrhosis, ICD-9 codes, administrative claims data, diagnostic accuracy, ascites, code combinations, safety-net hospitals, positive predictive value, sensitivity and specificity
MeSH terms: Female, Humans, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, ROC Curve, Sensitivity and Specificity, Cohort Studies, International Classification of Diseases, Electronic Health Records, Clinical Coding

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Use of Administrative Claims Data for Identifying Patients with Cirrhosis

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