title: Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease?
abstract: OBJECTIVE
  Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug-resistant microorganisms (V09) for identifying culture-proven MRSA infection.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The κ statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.
  
  
  RESULTS
  There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%-34%) and positive predictive value of 31% (range, 22%-53%). The agreement between assignment of the V09 code and presence of MRSA infection had a κ coefficient of 0.26 (95% confidence interval, 0.25-0.27).
  
  
  CONCLUSIONS
  In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.
authors: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. marin-schweizer@uiowa.edu
authors: Marin L
authors: ML
authors: Schweizer
authors: Michael R
authors: MR
authors: Eber
authors: Ramanan
authors: R
authors: Laxminarayan
authors: Jon P
authors: JP
authors: Furuno
authors: Kyle J
authors: KJ
authors: Popovich
authors: Bala
authors: B
authors: Hota
authors: Michael A
authors: MA
authors: Rubin
authors: Eli N
authors: EN
authors: Perencevich
mesh_terms: D015142:Baltimore / Q000453:epidemiology; D002641:Chicago / Q000453:epidemiology; D002908:Chronic Disease; D059019:Clinical Coding / Q000592:standards*; D015994:Incidence; D038801:International Classification of Diseases; D055624:Methicillin-Resistant Staphylococcus aureus; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D014589:Utah / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000382:microbiology