Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T03:56:24.910Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Reporting Methicillin-Resistant Staphylococcus aureus Infections at a Hospital in Illinois

Published online by Cambridge University Press:  02 January 2015

Melissa K. Schaefer ,
Katherine Ellingson ,
Craig Conover ,
Alicia E. Genisca ,
Donna Currie ,
Tina Esposito ,
Laura Panttila ,
Peter Ruestow ,
Karen Martin  and
Diane Cronin
...Show all authors
Melissa K. Schaefer*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Katherine Ellingson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Craig Conover
Affiliation:
Illinois Department of Public Health, Springfield, Illinois
Alicia E. Genisca
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Donna Currie
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Tina Esposito
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Laura Panttila
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Peter Ruestow
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Karen Martin
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Diane Cronin
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Michael Costello
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Stephen Sokalski
Affiliation:
Advocate Health Care, Oakbrook, Illinois
Scott Fridkin
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road NE, Mailstop A-31, Atlanta, GA 30333, (mschaefer@cdc.gov)
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 463 - 468
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.CrossRefGoogle ScholarPubMed
2.Scott, RD II. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf. Published March 2009. Accessed June 22, 2009.Google Scholar
3.Klevens, RM, Edwards, JR, Richards, CL, et al.Estimating health care-associated infections and deaths in US hospitals. Public Health Rep 2007;122:160–166.CrossRefGoogle Scholar
4.Edmond, MB, Bearman, GML. Mandatory public reporting in the USA: an example to follow? J Hosp Infect 2007;65(suppl 2):182–188.CrossRefGoogle ScholarPubMed
5.Meier, BM, Stone, PW, Gebbie, KM. Public health law for the collection and reporting of health care-associated infections. Am J Infect Control 2008;36:537–551.CrossRefGoogle ScholarPubMed
6. Association for Professionals in Infection Control. MRSA laws and pending legislation—2009. APIC Web site, http://www.apic.org/am/images/maps/mrsa_map.gif. Published 2008. Accessed July 31, 2009.Google Scholar
7. Public Act 095-0312 (IL 2007). Illinois General Assembly Web site, http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name = 095-0312. Accessed January 28, 2008.Google Scholar
8. Public Act 095-0282 (IL 2007). Illinois General Assembly Web site, http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name = 095-0282. Accessed March 3, 2008.Google Scholar
9.Sherman, ER, Heydon, KH, St John, KH, et al.Administrative data fail to accurately identify cases of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:332–337.CrossRefGoogle ScholarPubMed
10.Stevenson, KB, Khan, Y, Dickman, J, et al.Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care-associated infections. Am J Infect Control 2008;36:155–164.CrossRefGoogle ScholarPubMed
11.Stone, PW, Horan, TC, Huai-Che, S, et al.Comparisons of health care-associated infections identification using two mechanisms for public reporting. Am J Infect Control 2007;35(3):145–149.CrossRefGoogle ScholarPubMed
12.Medicare Program; proposed changes to the hospital inpatient prospective payment systems for acute care hospitals and fiscal year 2010 rates and to the long-term care hospital prospective payment system and rate year 2010 rates. Fed Regist 2009;74(98):24089.Google Scholar
13. Medicare claims processing manual. Centers for Medicare and Medicaid Services Web site, http://www.cms.hhs.gov/manuals/downloads/clml04 c25.pdf. Accessed June 23, 2009.Google Scholar
14.Mitchell, CL, Anderson, ER, Braun, L. Billing for inpatient hospital care. Am J Health Syst Pharm 2003;60(21suppl 6):S8–S11.CrossRefGoogle ScholarPubMed
15.Cohen, AL, Calfee, D, Fridkin, SK, et al.Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29(10):901–913.CrossRefGoogle ScholarPubMed
16.Klevens, RM, Morrison, MA, Fridkin, SL, et al.Community-associated meth-icillin-resistant Staphylococcus aureus (MRSA) and healthcare risk factors. Emerg Infect Dis 2006;12(12):1991–1993.CrossRefGoogle Scholar
17. Hospital-acquired conditions (present on admission indicator). Centers for Medicare and Medicaid Services Web site, http://www.cms.hhs.gov/HospitalAcqCond/. Accessed January 6, 2009.Google Scholar
18.Medicare Program; changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist 2007;72(162):47200–47218.Google Scholar
19. National Center for Health Statistics. ICD-9-CM Official Guidelines for Coding and Reporting. Centers for Disease Control and Prevention Web site, http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm-#addenda. Accessed June 5, 2009.Google Scholar