Validation of current procedural terminology codes for rotavirus vaccination among infants in two commercially insured US populations.
We validated procedure codes used in health insurance claims for reimbursement of rotavirus vaccination by comparing claims for monovalent live-attenuated human rotavirus vaccine (RV1) and live, oral pentavalent rotavirus vaccine (RV5) to medical records.



Using administrative data from two commercially insured United States populations, we randomly sampled vaccination claims for RV1 and RV5 from a cohort of infants aged less than 1 year from an ongoing post-licensure safety study of rotavirus vaccines. The codes for RV1 and RV5 found in claims were confirmed through medical record review. The positive predictive value (PPV) of the Current Procedural Terminology codes for RV1 and RV5 was calculated as the number of medical record-confirmed vaccinations divided by the number of medical records obtained.



Medical record review confirmed 92 of 104 RV1 vaccination claims (PPV: 88.5%; 95% CI: 80.7-93.9%) and 98 of 113 RV5 vaccination claims (PPV: 86.7%; 95% CI: 79.1-92.4%). Among the 217 medical records abstracted, only three (1.4%) of vaccinations were misclassified in claims-all were RV5 misclassified as RV1. The medical records corresponding to 9 RV1 and 15 RV5 claims contained insufficient information to classify the type of rotavirus vaccine.



Misclassification of rotavirus vaccines is infrequent within claims. The PPVs reported here are conservative estimates as those with insufficient information in the medical records were assumed to be incorrectly coded in the claims. Copyright © 2016 John Wiley & Sons, Ltd.
Optum Epidemiology, Ann Arbor, MI, USA.
Veena
V
Hoffman
Optum Epidemiology, Boston, MA, USA.
Nicholas J
0000-0001-7216-7836
NJ
Everage
HealthCore, Inc., Wilmington, DE, USA.
Scott C
SC
Quinlan
Optum Epidemiology, Boston, MA, USA.
Kathleen
K
Skerry
HealthCore, Inc., Wilmington, DE, USA.
Daina
D
Esposito
GSK Vaccines, Wavre, Belgium.
Nicolas
N
Praet
GSK Vaccines, Wavre, Belgium.
Dominique
D
Rosillon
HealthCore, Inc., Wilmington, DE, USA.
Crystal N
CN
Holick
Optum Epidemiology, Boston, MA, USA.|Brown University School of Public Health, Providence, RI, USA.
David D
DD
Dore
D039702:Current Procedural Terminology; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D011237:Predictive Value of Tests; D012400:Rotavirus Infections / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D014481:United States; D014611:Vaccination / Q000191:economics; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000191:economics
C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
health insurance claims data; pharmacoepidemiology; positive predictive value; rotavirus vaccination; validation