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Original Research: COPD |

The Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Diagnosis Codes for Identifying Patients Hospitalized for COPD ExacerbationsValidity of Diagnosis Codes in COPD Exacerbations

Brian D. Stein, MD; Adriana Bautista, MD; Glen T. Schumock, PharmD; Todd A. Lee, PharmD, PhD; Jeffery T. Charbeneau, MS; Diane S. Lauderdale, PhD; Edward T. Naureckas, MD, FCCP; David O. Meltzer, MD, PhD; Jerry A. Krishnan, MD, PhD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Stein), Rush University Medical Center; Center for Pharmacoeconomic Research (Drs Bautista, Schumock, and Lee), Section of Pulmonary, Critical Care, Sleep and Allergy (Dr Krishnan), University of Illinois at Chicago; Center for Management of Complex Chronic Care (Dr Lee), Hines VA Hospital; and Department of Health Studies (Mr Charbeneau and Dr Lauderdale), Section of Pulmonary and Critical Care Medicine (Dr Naureckas), and Section of Hospital Medicine (Dr Meltzer), University of Chicago, Chicago, IL.

Correspondence to: Jerry A. Krishnan, MD, PhD, FCCP, University of Illinois at Chicago, 840 S Wood St (MC 719), Chicago, IL 60612; e-mail: jakris@uic.edu


Funding/Support: This work was supported by the National Institutes of Health [HL07605, HL101618] and the Agency for Healthcare Research and Quality [HS016967, HS017894].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):87-93. doi:10.1378/chest.11-0024
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Background:  Acute exacerbations of COPD (AE-COPD) are a leading cause of hospitalizations in the United States. To estimate the burden of disease (eg, prevalence and cost), identify opportunities to improve care quality (eg, performance measures), and conduct observational comparative effectiveness research studies, various algorithms based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes have been used to identify patients with COPD. However, the validity of these algorithms remains unclear.

Methods:  We compared the test characteristics (sensitivity, specificity, positive predictive value, and negative predictive value) of four different coding algorithms for identifying patients hospitalized for an exacerbation of COPD with chart review (reference standard) using a stratified probability sample of 200 hospitalizations at two urban academic medical centers. Sampling weights were used when calculating prevalence and test characteristics.

Results:  The prevalence of COPD exacerbations (based on the reference standard) was 7.9% of all hospitalizations. The sensitivity of all ICD-9-CM algorithms was very low and varied by algorithm (12%-25%), but the negative predictive value was similarly high across algorithms (93%-94%). The specificity was > 99% for all algorithms, but the positive predictive value varied by algorithm (81%-97%).

Conclusions:  Algorithms based on ICD-9-CM codes will undercount hospitalizations for AE-COPD, and as many as one in five patients identified by these algorithms may be misidentified as having a COPD exacerbation. These findings suggest that relying on ICD-9-CM codes alone to identify patients hospitalized for AE-COPD may be problematic.

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