Accuracy of administrative billing codes to detect urinary tract infection hospitalizations

Joel S. Tieder, Matthew Hall, Katherine A. Auger, Paul D. Hain, Karen E. Jerardi, Angela L. Myers, Suraiya S. Rahman, Derek J. Williams, Samir S. Shah

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

BACKGROUND: Hospital billing data are frequently used for quality measures and research, but the accuracy of the use of discharge codes to identify urinary tract infections (UTIs) is unknown. OBJECTIVE: To determine the accuracy of International Classification of Diseases, 9th revision (ICD-9) discharge codes to identify children hospitalized with UTIs. METHODS: This multicenter study conducted in 5 children's hospitals included children aged 3 days to 18 years who had been admitted to the hospital, undergone a urinalysis or urine culture, and discharged from the hospital. Data were obtained from the pediatric health information system database and medical record review. With the use of 2 gold-standard methods, the positive predictive value (PPV) was calculated for individual and combined UTI codes and for common UTI identification strategies. PPV was measured for all groupings for which the UTI code was the principal discharge diagnosis. RESULTS: There were 833 patients in the study. The PPV was 50.3% with the use of the gold standard of laboratory-confirmed UTIs but increased to 85% with provider confirmation. Restriction of the study cohort to patients with a principle diagnosis of UTI improved the PPV for laboratory-confirmed UTI (61.2%) and provider-confirmed UTI (93.2%), as well as the ability to benchmark performance. Other common identification strategies did not markedly affect the PPV. CONCLUSIONS: ICD-9 codes can be used to identify patients with UTIs but are most accurate when UTI is the principal discharge diagnosis. The identification strategies reported in this study can be used to improve the accuracy and applicability of benchmarking measures.

Original languageEnglish (US)
Pages (from-to)323-330
Number of pages8
JournalPediatrics
Volume128
Issue number2
DOIs
Publication statusPublished - Aug 2011

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Keywords

  • Hospital performance
  • Length of stay
  • Quality improvement
  • Quality of care
  • Urinary tract infections

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Tieder, J. S., Hall, M., Auger, K. A., Hain, P. D., Jerardi, K. E., Myers, A. L., ... Shah, S. S. (2011). Accuracy of administrative billing codes to detect urinary tract infection hospitalizations. Pediatrics, 128(2), 323-330. https://doi.org/10.1542/peds.2010-2064