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Can Additional Information Be Obtained from Claims Data to Support Surgical Site Infection Diagnosis Codes?

Published online by Cambridge University Press:  10 May 2016

David K. Warren ,
Katelin B. Nickel ,
Anna E. Wallace ,
Daniel Mines ,
Victoria J. Fraser  and
Margaret A. Olsen
David K. Warren
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
Anna E. Wallace
Affiliation:
HealthCore, Wilmington, Delaware
Daniel Mines
Affiliation:
HealthCore, Wilmington, Delaware
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, Missouri
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Objective.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.

Methods.

We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old with ICD-9-CM procedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified by ICD-9-CM diagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.

Results.

Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.

Conclusions.

More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S124 - S132
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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