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PubMed2000

Coding plastic surgery operations: an audit of performance using OPCS-4.

Accurate coding is essential for local and national data reporting and for contracting. It is also integral to clinical governance. This study aimed to assess the accuracy of coding in Morriston Hospital plastic surgery theatres and coding office, to reaudit and address poor practice. A third coding system, a computerised logbook developed by the senior author, was not analysed in this study. Fifty operations coded using OPCS-4 were compared with a gold standard for overall accuracy, primary and procedural codes. Results were discussed with all relevant staff and reaudit took place 3 months later. The data were analysed using the paired Student's t -test for intergroup comparisons and the unpaired test for intragroup assessment. At initial audit, the coding office was significantly better than theatre staff in overall accuracy (78% vs 43% respectively P<< 0.01) and in procedural codes (98% vs 42%, P<< 0.01) but there was no difference in primary codes (62% vs 74%). At reaudit the only significant improvement was in overall accuracy of coding office records, although the clinical coders were now significantly better at recording primary codes than theatre staff (76% vs 56%, P< 0.05). The conclusions were that the quality of coding in theatre was poor and should stop. Clinical coders performed better but 1/3-1/4 of essential codes were inaccurate. This may have been due to limited understanding of terminology and techniques, difficulty reading operation notes and complexity of OPCS-4. Recommendations included closer cooperation between surgeons and coders to support and improve clinical coding performance.

Forms and Records Control↗

PubMed2003

Coding accuracy for endophthalmitis diagnosis and cataract procedures in Western Australia. The Endophthalmitis Population Study of Western Australia (EPSWA): second report.

As an initial phase of the Endophthalmitis Population Study of Western Australia (EPSWA), this paper reports the results from an intensive comparative validation of all possible surgery-related endophthalmitis cases identified for the period from 1980 to June 1999 from the Hospital Morbidity Data System (HMDS) of the WA Record Linkage Project with external sources. The external sources were the microbiology and anaesthetic databases from Royal Perth Hospital (where most of the cases of endophthalmitis were treated) and surgeon logbooks of two vitreoretinal surgeons treating endophthalmitis in Perth over the study period. As it was discovered that a large proportion of all cases coded with endophthalmitis did not have any ocular surgery, the validation also included a sample from these cases. The purpose of validating these cases was to ensure that our count of post-operative endophthalmitis had not excluded any cases whose surgery might not have been recorded in the HMDS database. It was also intended to provide an estimate of all miscoded endophthalmitis cases as a first step towards future improvement of coding accuracy. Since we suspected that phaco-emulsification was under-coded, we also examined a sample of cataract procedures. Of all surgery-related endophthalmitis cases coded in the HMDS, only 50.9% (274 of 538) were found to be valid cases. External sources identified 83 cases of endophthalmitis, 49 did not have endophthal-mitis codes but were in the HMDS file with an associated code. Of the remaining externally identified cases, 13 were missing altogether from the HMDS file, 7 of which were correctly coded in the notes while the other 6 were coded with associated codes, and 21 were diagnosed after the date the HMDS file was extracted. The validation of a random sample of the non-surgery-related cases coded with endophthalmitis suggested that the vast majority of them were miscoded (88%, 139 of 158 sampled from 1474 cases). The systematic coding errors reported in this paper may be attributed to both the clinical and the coding departments of the hospital. In any case, coding inaccuracy itself is a serious concern for data quality of any linked database systems and for epidemiological researchers using such data. The increased use of aggregated data in epidemiological research further underscores the importance of coding accuracy and thus data validation. The use of external sources for case identification and case validation are two ways of ensuring data completeness/quality and validity of results.

Cataract↗

PubMed1998

Neural representation of objects in space: a dual coding account.

I present evidence on the nature of object coding in the brain and discuss the implications of this coding for models of visual selective attention. Neuropsychological studies of task-based constraints on: (i) visual neglect; and (ii) reading and counting, reveal the existence of parallel forms of spatial representation for objects: within-object representations, where elements are coded as parts of objects, and between-object representations, where elements are coded as independent objects. Aside from these spatial codes for objects, however, the coding of visual space is limited. We are extremely poor at remembering small spatial displacements across eye movements, indicating (at best) impoverished coding of spatial position per se. Also, effects of element separation on spatial extinction can be eliminated by filling the space with an occluding object, indicating that spatial effects on visual selection are moderated by object coding. Overall, there are separate limits on visual processing reflecting: (i) the competition to code parts within objects; (ii) the small number of independent objects that can be coded in parallel; and (iii) task-based selection of whether within- or between-object codes determine behaviour. Between-object coding may be linked to the dorsal visual system while parallel coding of parts within objects takes place in the ventral system, although there may additionally be some dorsal involvement either when attention must be shifted within objects or when explicit spatial coding of parts is necessary for object identification.

Brain↗

PubMed2006

Arbitrary waveform coded excitation using bipolar square wave pulsers in medical ultrasound.

This paper presents a new coded excitation scheme that efficiently synthesizes codes for arbitrary waveforms using a bipolar square wave pulser. In a coded excitation system, pulse compression is performed to restore the axial resolution. In order to maintain low range sidelobes, the system needs to transmit signals that have smooth spectra. However, such a transmitter requires the generation of arbitrary waveforms and, therefore, is more expensive. In other words, a trade-off is necessary between the compression performance and the transmitter cost. Here we propose a method that preserves the low-cost advantage of a bipolar pulser while achieving approximately the same compression performance as an arbitrary waveform generator. The key idea of the proposed method is the conversion of a nonbinary code (i.e., requiring an arbitrary waveform generator) with good compression performance into a binary code (i.e., requiring only a bipolar pulser) by code translation and code tuning. The code translation is implemented by sending the nonbinary code into a virtual one-bit, sigma-delta modulator, and the code tuning involves minimizing the root-mean-square error between the resultant binary code and the original nonbinary code by sequential and iterative tuning while taking the transducer response into account. Tukey-windowed chirps are known to have good compression performance. Such chirps of different durations (16, 20, and 24 micros), all with a taper ratio of 0.15, a center frequency of 2.5 MHz, and an equivalent bandwidth of 1.5 MHz, were converted into binary Tukey-windowed chirps that were compared with pseudochirps (i.e., direct binary approximations of the original chirp) over the same spectral band. The bit rate was 40 MHz. Simulation results show that the use of binary Tukey-windowed chirps can reduce the code duration by 20.6% or the peak sidelobe level by 6 dB compared to the commonly used pseudochirps. Experimental results obtained under the same settings were in agreement with the simulations. Our results demonstrate that arbitrary waveform coded excitation can be realized using bipolar square wave pulsers for applications in medical ultrasound.

Algorithms↗

PubMed2004

Incomplete and biased perpetrator coding among hospitalized assaults for women in the United States.

BACKGROUND: Since 1997, hospital discharge data have included external cause of injury (E codes) for designating perpetrator relationship in assaults. For intentional injuries, guidelines require using two E codes; one for the injury mechanism and another (E967.n) identifying perpetrator relationship. Completeness and characteristics of the use of these codes have not been studied on a multistate level among states with complete E coding. METHODS: Hospital discharge data for 1997 were solicited from states with good E coding completeness. Data were received from 19 states (51.9% of women in the United States, ages 15-49). For assaulted women, a regression model was constructed to identify factors associated with perpetrator code assignment using age, payment source, pregnancy status, race, and severity as covariates. RESULTS: Among 137 887 injured hospitalized women age 15-49, there were 7402 assaults (5.4%). Among all assaults to women, perpetrator coding was poor (8.8%). Among those that were perpetrator coded, 83.7% were spouse/partner related. Age was positively associated with probability of having a perpetrator code (p<0.001). Those paid by a private source were 42.9% more likely to have a perpetrator code (p = 0.007). Pregnant women were seven times more likely to have a perpetrator code (p<0.001). Non-white women were 66.8% less likely to have a perpetrator code (p<0.001) than white women. CONCLUSIONS: The poor use of perpetrator codes in hospital discharge data minimizes their usefulness for surveillance of serious injury from intimate partner violence. An implication of this research is the need to understand the gaps and strengthen the completeness of perpetrator documentation and coding. The findings suggest caution when interpreting the results from existing hospital discharge data based intimate partner violence surveillance systems.

Adolescent↗

PubMed2001

An electronic documentation system increases diagnostic code capture for very low birth weight infants.

INTRODUCTION: Information describing medical interventions and patient outcome of very low birth weight (VLBW; BW <1500 grams) infants who receive neonatal intensive care is necessary to evaluate the quality of health care. We developed an electronic patient documentation system (EDS) called PCode to identify and select patient diagnostic (DX) codes and compared EDS to the previous paper-based documentation system (PDS). Our hypothesis was that EDS would capture more patient diagnostic codes than PDS. METHODS: PDS was originally developed as a two page 'code sheet' which listed all 275 neonatal diagnoses/management options and corresponding 3-4 character diagnostic (DX) codes, organized by organ system. PDS code sheets were manually completed by one of three trained 'coders' for every neonatal patient. EDS was developed as a Java application with the 'coder' selecting DX codes from drop lists also categorized by organ system. The study intervention was patient code selection using either the PDS or the EDS system. Both systems produced a paper DX code summary. PDS data capture occurred from 11/1997-3/1999 followed by EDS data capture until 8/2000. The primary outcome variable was DX codes captured per patient. Data were analyzed using independent t-test and linear regression. RESULTS: The number of diagnoses increased with decreasing birth weight. After linear regression was applied to control for birth weight, the number of DX codes was 31% greater in the EDS group, 7.2 +/- 2.9 DX codes/patient, p=0.008. There was a trend towards fewer erroneous DX codes in the EDS group. The most common DX codes were hyaline membrane disease, sepsis evaluation and hyperbilirubinemia, as expected for this patient population. CONCLUSIONS: EDS captured more VLBW infant DX codes compared to PDS. These results support the transition toward electronic data documentation for the neonatal clinical environment. Electronically linking PCode to the patient database has been initiated and should reduce manual coding errors.

Diagnosis↗

PubMed1992

Code domains in tandem repetitive DNA sequence structures.

Traditionally, many people doing research in molecular biology attribute coding properties to a given DNA sequence if this sequence contains an open reading frame for translation into a sequence of amino acids. This protein coding capability of DNA was detected about 30 years ago. The underlying genetic code is highly conserved and present in every biological species studied so far. Today, it is obvious that DNA has a much larger coding potential for other important tasks. Apart from coding for specific RNA molecules such as rRNA, snRNA and tRNA molecules, specific structural and sequence patterns of the DNA chain itself express distinct codes for the regulation and expression of its genetic activity. A chromatin code has been defined for phasing of the histone-octamer protein complex in the nucleosome. A translation frame code has been shown to exist that determines correct triplet counting at the ribosome during protein synthesis. A loop code seems to organize the single stranded interaction of the nascent RNA chain with proteins during the splicing process, and a splicing code phases successive 5' and 3' splicing sites. Most of these DNA codes are not exclusively based on the primary DNA sequence itself, but also seem to include specific features of the corresponding higher order structures. Based on the view that these various DNA codes are genetically instructive for specific molecular interactions or processes, important in the nucleus during interphase and during cell division, the coding capability of tandem repetitive DNA sequences has recently been reconsidered.

Animals↗

PubMed2004

Codon usage bias and mutation constraints reduce the level of error minimization of the genetic code.

Studies on the origin of the genetic code compare measures of the degree of error minimization of the standard code with measures produced by random variant codes but do not take into account codon usage, which was probably highly biased during the origin of the code. Codon usage bias could play an important role in the minimization of the chemical distances between amino acids because the importance of errors depends also on the frequency of the different codons. Here I show that when codon usage is taken into account, the degree of error minimization of the standard code may be dramatically reduced, and shifting to alternative codes often increases the degree of error minimization. This is especially true with a high CG content, which was probably the case during the origin of the code. I also show that the frequency of codes that perform better than the standard code, in terms of relative efficiency, is much higher in the neighborhood of the standard code itself, even when not considering codon usage bias; therefore alternative codes that differ only slightly from the standard code are more likely to evolve than some previous analyses suggested. My conclusions are that the standard genetic code is far from being an optimum with respect to error minimization and must have arisen for reasons other than error minimization.

Base Composition↗

PubMed2003

Characterisation of a non-canonical genetic code in the oxymonad Streblomastix strix.

The genetic code is one of the most highly conserved characters in living organisms. Only a small number of genomes have evolved slight variations on the code, and these non-canonical codes are instrumental in understanding the selective pressures maintaining the code. Here, we describe a new case of a non-canonical genetic code from the oxymonad flagellate Streblomastix strix. We have sequenced four protein-coding genes from S.strix and found that the canonical stop codons TAA and TAG encode the amino acid glutamine. These codons are retained in S.strix mRNAs, and the legitimate termination codons of all genes examined were found to be TGA, supporting the prediction that this should be the only true stop codon in this genome. Only four other lineages of eukaryotes are known to have evolved non-canonical nuclear genetic codes, and our phylogenetic analyses of alpha-tubulin, beta-tubulin, elongation factor-1 alpha (EF-1 alpha), heat-shock protein 90 (HSP90), and small subunit rRNA all confirm that the variant code in S.strix evolved independently of any other known variant. The independent origin of each of these codes is particularly interesting because the code found in S.strix, where TAA and TAG encode glutamine, has evolved in three of the four other nuclear lineages with variant codes, but this code has never evolved in a prokaryote or a prokaryote-derived organelle. The distribution of non-canonical codes is probably the result of a combination of differences in translation termination, tRNAs, and tRNA synthetases, such that the eukaryotic machinery preferentially allows changes involving TAA and TAG.

Amino Acid Sequence↗

PubMed1993

Childhood cancer in relation to a modified residential wire code.

Several studies have found associations between wire configuration codes, a proxy for historical residential magnetic field exposure, and childhood cancer. The Wertheimer-Leeper coding method was modified by eliminating the distinction between thick and thin primaries, distinguishing only between open and spun secondaries, and reducing the number of categories from five to three. The association between the modified code and measured magnetic fields was similar to the association with the original wire code. The modified code was used to reanalyze data from a case-control study of childhood cancer in the Denver metropolitan area. In the original study, cases were diagnosed from 1976 to 1983 among children under age 15 and compared to controls selected through random digit dialing. Wire codes for the residence at diagnosis yielded imprecise elevations of two and above for very high current configuration homes or modest 1.5-fold elevations for a dichotomous wire code. In contrast, the modified Wertheimer-Leeper code generated risk estimates that were both precise and markedly elevated for the high wire code (HWC) compared to low wire code (LWC) classifications, with medium wire code (MWC) showing little or no increase in risk. High wire code yielded odds ratios of 1.9 for total cancers (95% CI: 1.1-3.2), 2.9 for leukemias (95% CI: 1.5-5.5), and 2.5 for brain cancer (95% CI: 1.1-5.5) that were not confounded by measured potential risk factors for childhood cancer. These risk estimates are larger than the dichotomized results and more precise than those from the original five-level wire code, though limitations in the original study remain, particularly potential control selection bias.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1996

Validation of a new computer program for Minnesota coding.

The Minnesota code (MC) is a classification system for electrocardiograms (ECGs) that is used for ECG coding in epidemiologic studies. As the MC measurement procedures and rules are complex, visual coding is time-consuming and error-prone. Automation should reduce measurement and coding errors. The authors developed an MC program, closely adhering to the MC regulations. To validate the program, a test set of 300 ECGs containing a wide variety of codable patterns was collected. The ECGs were coded independently by the program and by an experienced human reader. A reference code ("truth") was established by resolving disagreements through a consensus procedure. If the computer and human agreed, they were considered to be correct. Sensitivity and specificity were computed for each of the nine main code categories of the MC, both for the computer and for visual coding. The results show that the program is as good as or better than the human reader for sensitivity and specificity of all MC categories. Particularly noteworthy is the good program performance for arrhythmia coding. Most coding differences between the program and truth arise from small, borderline measurement differences in combination with the all-or-none character of the coding criteria. In conclusion, computerized Minnesota coding is a valuable alternative or supplement to visual coding.

Arrhythmias, Cardiac↗

PubMed2003

Wire coding in the EMF and Breast Cancer on Long Island Study: relationship to magnetic fields.

The Electromagnetic Fields and Breast Cancer on Long Island Study (EBCLIS) is a large population-based case-control study investigating possible associations between magnetic fields and breast cancer, and includes a comprehensive set of in-home measurements. We investigated the reproducibility of wire codes, their relation to 24-h measurements of residential magnetic fields, and potential influences, such as housing characteristics, in homes of the 1161 EBCLIS participants. Replicate wire coding was performed in homes originally categorized as having very high current configurations (VHCC) in the Wertheimer-Leeper (W-L) wire coding scheme, and a random sample of other homes (235 residences). Reproducibility was very high, with a kappa statistic of 0.83 (95% confidence interval (CI)=0.77-0.89) for the five-category W-L wire codes and 0.91 (95% CI=0.86-0.95) for the three-category Kaune-Savitz (K-S) codes. As levels of W-L and K-S wire codes increased, the mean and median 24-h levels of broadband and harmonic fields in the residences also increased, indicating an association between wire codes and magnetic fields measurements. Regions of Long Island with the highest percentage of homes built before 1950 had the highest percentage of higher current configuration homes, as well as the highest average 24-h broadband and harmonic measurements. Adjustment for age of the home and region did not affect the relation between wire codes and measured magnetic fields. Our results indicate that: (a). a high reproducibility in wire coding was achieved, (b). wire codes were correlated with magnetic fields, and (c). wire code levels were related to the age of the home. The high level of reproducibility suggests that, in our case-control analyses, there will be minimal bias due to misclassification of wire code categories. Results also suggest that wire codes are a proxy measure, to some degree, for current in-home magnetic field measurements in this study.

Aged↗

PubMed2001

Coding diagnoses and procedures using a high-quality clinical database instead of a medical record review.

A discharge abstract must be completed for each hospitalization. The most time-consuming component of this task is a complete review of the doctors' progress notes to identify and code all diagnoses and procedures. We have developed a clinical database that creates hospital discharge summaries. To compare diagnostic and procedural coding from a clinical database vs. the standard chart review by health records analysts (HRA). All patients admitted and discharged from general medical and surgical services at a teaching hospital in Ontario, Canada. Diagnostic and procedural codes were identified by reviewing discharge summaries generated from a clinical database. Independently, codes were identified by hospital health records analysts using chart review alone. Codes were compared with a gold standard case review conducted by a health records analyst and a doctor. Coding accuracy (percentage of codes in gold standard review) and completeness (percentage of gold standard codes identified). The study included 124 patients (mean length of stay 5.5 days; 66.4% medical patients). The accuracy of the most responsible diagnosis was 68.5% and 62.9% for the database (D) and chart review (C), respectively (P = 0.18). Overall, the database significantly improved the accuracy (D = 78.9% vs. C = 74.5%; P = 0.02) and completeness (D = 63.9% vs. C = 36.7%; P < 0.0001) of diagnostic coding. Although completeness of procedural coding was similar (D = 5.4% vs. C = 64.2%; P = NS), accuracy decreased with the database (D = 70.3% vs. C = 92.2%; P < 0.0001). Mean resource intensity weightings calculated from the codes (D = 1.3 vs. C = 1.4; P = NS) were similar. Coding from a clinical database may circumvent the need for HRAs to review doctors' progress notes, while maintaining the quality of coding in the discharge abstract.

Database Management Systems↗

PubMed2002

The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group.

In light of evolving pacemaker technology and increasing interest in multisite pacing, the Committee on the Development of Position Statements (CDPS) of the North American Society of Pacing and Electrophysiology (NASPE) created an ad hoc Pacemaker Mode Code Task Force in April 2001 under the chairmanship of David L. Hayes, MD, for the purpose of bringing the NASPE/British Pacing and Electrophysiology Group (BPEG) Generic Pacemaker Code (NBG Code) up to date. The task force, whose members are the authors of this article, designed a revised NBG Code in which three major issues were taken into account. First, it was recognized that all modern pacemakerpulse generators are capable of extensive bidirectional communication with an external programming device, making them "communicating" pulse generators as defined by the current (1987) NBG Code. Second, it was decided that a means of providing basic information regarding the location of multisite pacing would be a useful ingredient of the NBG Code. Third, in view of the extensive antibradycardia pacing capabilities common in modern implantable cardioverter defibrillators and the availability of the NASPE/BPEG Defibrillator Code (NBD Code), it was considered unnecessary for the NBG Code to address the presence or absence of antitachycardia features. The resulting updated version of the NBG Code as described herein was endorsed by the BPEG on September 20, 2001 and adopted by the NASPE Board of Trustees on October 18, 2001. The structure of the revised NBG Code differs from that of the previous version in two respects alone: Position IV specifies only the presence or absence of rate modulation, and Position V specifies only the location or absence of multisite pacing (i.e., biatrial or biventricular pacing with at least two stimulation sites in each case) more than one stimulation site in any single cardiac chamber, or any combination of these. The revised NBG Code is deliberately configured to avoid confusion with earlier mode codes, and it is the authors' hope that it will serve as an enhanced resource for communication among those engaged in every phase of the multidisciplinary practice of cardiac rhythm management.

Bradycardia↗

PubMed1998

Assessment of the reproducibility of clinical coding in routinely collected hospital activity data: a study in two hospitals.

BACKGROUND: The aim of the study was to assess the reproducibility of clinical coding in two National Health Service hospitals within North West Thames region. METHODS: A retrospective audit was carried out, of clinical coding in hospital episode statistics, involving comparison of the codes assigned by local staff with those assigned by members of an external team unaware of the locally assigned codes. Where local and external coders disagreed, the records were reviewed for a third time by a further independent coder. The subjects were a random sample of 1607 non-maternity, non-psychiatric admissions occurring between 1991 and 1993, stratified for year and type of disease (asthma, diabetes, appendicitis, fractured femur and 'general'--a random selection of any diagnoses). The main outcome measures were the levels of exact agreement between local and external teams over codes for main diagnosis and procedure, and the level of approximate agreement (over the first three characters of the ICD-9 code for diagnosis and the letter and first two digits of the OPCS-4 code for procedure). For disagreements, the outcome measure was the level of agreement between the 'third' coder and the local and external coders. RESULTS: For the main diagnosis in the 'general' group at hospital A, internal and external coders agreed exactly in 43 per cent of the admissions examined and agreed 'approximately' in 55 per cent (kappa = 0.54). For hospital B the corresponding figures were 60 per cent and 72 per cent (kappa = 0.72). Approximate agreement was higher for the specific diseases considered, particularly for asthma (A: 86 per cent; B: 91 per cent) and fractured femur (A: 84 per cent; B: 89 per cent). For the main procedure at hospital A, there was exact agreement for 58 per cent and approximate agreement for 70 per cent (kappa = 0.66). For hospital B, the corresponding figures were 76 per cent and 83 per cent (kappa = 0.80). In cases of disagreement over the first three digits of the ICD-9 code for main diagnosis, the third coder disagreed with both local and external coders in 53 per cent at hospital A and 38 per cent at hospital B. Agreement was slightly better for discharges in 1992-1993 than in 1991-1992. CONCLUSIONS: The full clinical codes in NHS hospital episode statistics (HES) data should be treated with caution. The first three characters of ICD-9 codes for diagnoses and the OPCS-4 codes for procedures were more reliable. For some specific conditions such as asthma and fractured femur, reliability of the first three characters is much higher (for example, 86 per cent and 91 per cent for asthma in the two hospitals), but for the full codes can be worse. Secondary diagnoses or comorbidities may be significantly undercoded. A higher level of agreement in 1992-1993 than in 1991-1992 suggests that coding may be improving.

Abstracting and Indexing↗

PubMed1994

An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding.

Two hundred ninety-five injury descriptions from 135 consecutive patients treated at a level-I trauma center were coded by three human coders (H1, H2, H3) and by TRI-CODE (T), a PC-based artificial intelligence software program. Two study coders are nationally recognized experts who teach AIS coding for its developers (the Association for the Advancement of Automotive Medicine); the third has 5 years experience in ICD and AIS coding. A "correct coding" (CC) was established for the study injury descriptions. Coding results were obtained for each coder relative to the CC. The correct ICD codes were selected in 96% of cases for H2, 92% for H1, 91% for T, and 86% for H3. The three human coders agreed on 222 (75%) injuries. The correct 7 digit AIS codes (six identifying digits and the severity digit) were selected in 93% of cases for H2, 87% for T, 77% for H3, and 73% for H1. The correct AIS severity codes (seventh digit only) were selected in 98.3% of cases for H2, 96.3% for T, 93.9% for H3, and 90.8% for H1. On the basis of the weighted kappa statistic TRI-CODE had excellent agreement with the correct coding (CC) of AIS severities. Each human coder had excellent agreement with CC and with TRI-CODE. Coders H1 and H2 were in excellent agreement. Coder H3 was in good agreement with H1 and H2. However, errors among the human coders often occur for different codes, accentuating the variability.(ABSTRACT TRUNCATED AT 250 WORDS)

Abbreviated Injury Scale↗

PubMed2006

Coding of glaucoma for patients with uveitis in the medicare database.

PURPOSE: To investigate possible causes for, and implications of, variations in coding of glaucoma for patients with uveitis in the Medicare database. PATIENTS AND METHODS: We identified 6,391 patients coded with one of several ICD-9 codes designating a form of uveitis from a 5% sample of the 1999 Medicare database. The proportion of patients with uveitis codes who also had codes for uveitic glaucoma, primary open-angle glaucoma (POAG), or unspecified open-angle glaucoma (OAG) were determined. The proportion with codes for argon laser trabeculoplasty (ALT), trabeculectomy, visual field examinations, fundus photographs, and gonioscopy were calculated in three groups: patients with both uveitis and uveitic glaucoma; those with both uveitis and POAG; and those with both uveitis and unspecified open-angle glaucoma. Summaries of the total allowed reimbursement related to eye visits and to eye codes were determined. RESULTS: Of the 6,391 patients with uveitis who were studied, 1,260 (19.7%) also had the code for POAG; 412 (6.4%) had the code for OAG; and 117 (1.8%) had the code for uveitic glaucoma. Visual field testing was less common among patients with uveitic glaucoma (37%) than among those with POAG/uveitis (46%) or OAG/uveitis (44%) (P < 0.001). There were no statistically significant differences among the three groups in the amount of total reimbursement related to eye services or eye codes. CONCLUSIONS: The code for POAG appears to be used in lieu of uveitic glaucoma in many cases. Discrepancies are probably not influenced by expected reimbursements, as much as by a lack of understanding about the available ICD-9 codes.

Databases, Factual↗

PubMed2006

Performance of International Classification Of Diseases, 9th Revision, Clinical Modification codes as an adverse drug event surveillance system.

BACKGROUND: Adverse drug events (ADEs) are one of the most frequent causes of iatrogenic injury. Because International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are routinely assigned to inpatient discharges, they could provide a method to detect ADEs within a hospital, a state, and the nation. OBJECTIVE: The objective of this study was to determine validity of selected ICD-9-CM codes in identifying inpatient ADEs. RESEARCH DESIGN: An expert panel identified 416 ICD-9-CM codes to represent ADEs (flagged ADE codes). Retrospective chart review using a structured tool was performed to ascertain code performance in detecting ADEs. SUBJECTS: Subjects included 3103 inpatients from all 41 acute care hospitals in Utah in 2001: 1961 inpatients sampled randomly (random sample) and 1142 inpatients sampled from the discharge records with at least one flagged ADE code (flagged sample). MEASURES: Measures were ADEs identified by structured review. RESULTS: The flagged sample yielded 1122 flagged ADE codes recorded in patient charts with 704 representing ADEs (63%). Two hundred eighty-six of the 704 verified ADE codes (41%) were determined to be inpatient ADEs. In the random sample, 32 of 58 ADEs (55%) causing hospital admission were detected by the ADE-flagged codes. Only 23 of 224 inpatient ADEs had been assigned a flagged ADE code (10%). CONCLUSIONS: Flagged ADE codes have an overall positive predictive value of 63% and detect just over half of ADEs causing hospital admission. These codes have a positive predictive value of 25% for inpatient ADEs but detect only 10% of overall inpatient ADEs. Flagged ADE codes provide an imperfect but immediately available ADE surveillance system.

Adverse Drug Reaction Reporting Systems↗