title: Positive predictive values of ICD-9 codes to identify patients with stroke or TIA.
abstract: OBJECTIVE
  To determine the positive predictive values of inpatient and outpatient ICD-9 codes and status code V12.54 for identifying confirmed history of stroke or transient ischemic attack (cerebral event) among patients within a managed care organization.
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  Inpatient hospital claims and outpatient visit records were used to identify patients with ICD-9 codes (430.XX to 438.XX) or status code V12.54 in the primary or secondary position recorded between January 1, 2001, and December 31, 2009. A standardized chart abstraction tool was used by trained chart abstractors blinded to the coding to confirm the cerebral event and classify stroke type. Positive predictive values (PPVs) were calculated for each code based on care setting.
  
  
  RESULTS
  A total of 4689 patients with 10,376 unique stroke codes recorded in the administrative data were reviewed. Of these, 2785 (59.4%) patients had a confirmed cerebral event. The codes with PPV less than 90% were 434.XX, 433 .X1, and V12.54 where codes were recorded in both the inpatient and outpatient settings. Overall, inpatient-only codes produced higher PPVs; however, relatively fewer events were captured in this setting.
  
  
  CONCLUSIONS
  Administrative ICD-9 codes 434.XX, 433.X1, and V12.54 had consistently high PPVs in identifying patients with a confirmed cerebral event. These codes could be used as part of a probabilistic approach to focus care activities on patients with the highest likelihood of a cerebral event.
authors.forename: Kari L
authors.initials: KL
authors.lastname: Olson
authors.forename: Michele D
authors.initials: MD
authors.lastname: Wood
authors.affiliation: 16601 E Centretech Parkway, Aurora, CO 80011. E-mail: tom.delate@kp.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Delate
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Lash
authors.forename: Jon
authors.initials: J
authors.lastname: Rasmussen
authors.forename: Anne M
authors.initials: AM
authors.lastname: Denham
authors.forename: John A
authors.initials: JA
authors.lastname: Merenich
mesh_terms: D002561:Cerebrovascular Disorders / Q000175:diagnosis; D006801:Humans; D038801:International Classification of Diseases; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008329:Managed Care Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*