title: Accuracy of the new ICD-9-CM code for "drip-and-ship" thrombolytic treatment in patients with ischemic stroke.
abstract: A new International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code, V45.88, was approved by the Centers for Medicare and Medicaid Services (CMS) on October 1, 2008. This code identifies patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated in one hospital's emergency department, followed by transfer within 24 hours to a comprehensive stroke center, a paradigm commonly referred to as "drip-and-ship." This study assessed the use and accuracy of the new V45.88 code for identifying ischemic stroke patients who meet the criteria for drip-and-ship at 2 advanced certified primary stroke centers. Consecutive patients over a 12-month period were identified by primary ICD-9-CM diagnosis codes related to ischemic stroke. The accuracy of V45.88 code utilization using administrative data provided by Health Information Management Services was assessed through a comparison with data collected in prospective stroke registries maintained at each hospital by a trained abstractor. Out of a total of 428 patients discharged from both hospitals with a diagnosis of ischemic stroke, 37 patients were given ICD-9-CM code V45.88. The internally validated data from the prospective stroke database demonstrated that a total of 40 patients met the criteria for drip-and-ship. A concurrent comparison found that 92% (sensitivity) of the patients treated with drip-and-ship were coded with V45.88. None of the non-drip-and-ship stroke cases received the V45.88 code (100% specificity). The new ICD-9-CM code for drip-and-ship appears to have high specificity and sensitivity, allowing effective data collection by the CMS.
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota Medical Center, Minneapolis, MN, USA. Stonare1@gmail.com
authors.forename: Silvina B
authors.initials: SB
authors.lastname: Tonarelli
authors.forename: Michael
authors.initials: M
authors.lastname: Tibbs
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vazquez
authors.forename: Kamakshi
authors.initials: K
authors.lastname: Lakshminarayan
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000046:Academic Medical Centers; D002545:Brain Ischemia / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy; D014487:Centers for Medicare and Medicaid Services, U.S.; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000145:classification*; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D038801:International Classification of Diseases; D010360:Patient Transfer / Q000145:classification*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012042:Registries; D020521:Stroke / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy; D009626:Terminology as Topic; D015912:Thrombolytic Therapy / Q000145:classification*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator