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Identification of patients with diabetic macular edema from claims data: a validation study.

Publication ,  Journal Article
Bearelly, S; Mruthyunjaya, P; Tzeng, JP; Suñer, IJ; Shea, AM; Lee, JT; Kowalski, JW; Curtis, LH; Schulman, KA; Lee, PP
Published in: Arch Ophthalmol
July 2008

OBJECTIVE: To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in administrative billing data from a convenience sample of physician offices. METHODS: A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the kappa statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion. RESULTS: The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records (kappa = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84; kappa = 0.64). CONCLUSIONS: The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.

Duke Scholars

Published In

Arch Ophthalmol

DOI

EISSN

1538-3601

Publication Date

July 2008

Volume

126

Issue

7

Start / End Page

986 / 989

Location

United States

Related Subject Headings

  • United States
  • Sensitivity and Specificity
  • Pilot Projects
  • Ophthalmology & Optometry
  • Macular Edema
  • International Classification of Diseases
  • Insurance Claim Review
  • Humans
  • Health Services Research
  • Diabetic Retinopathy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bearelly, S., Mruthyunjaya, P., Tzeng, J. P., Suñer, I. J., Shea, A. M., Lee, J. T., … Lee, P. P. (2008). Identification of patients with diabetic macular edema from claims data: a validation study. Arch Ophthalmol, 126(7), 986–989. https://doi.org/10.1001/archopht.126.7.986
Bearelly, Srilaxmi, Prithvi Mruthyunjaya, Janice P. Tzeng, Ivan J. Suñer, Alisa M. Shea, Jeffrey T. Lee, Jonathan W. Kowalski, Lesley H. Curtis, Kevin A. Schulman, and Paul P. Lee. “Identification of patients with diabetic macular edema from claims data: a validation study.Arch Ophthalmol 126, no. 7 (July 2008): 986–89. https://doi.org/10.1001/archopht.126.7.986.
Bearelly S, Mruthyunjaya P, Tzeng JP, Suñer IJ, Shea AM, Lee JT, et al. Identification of patients with diabetic macular edema from claims data: a validation study. Arch Ophthalmol. 2008 Jul;126(7):986–9.
Bearelly, Srilaxmi, et al. “Identification of patients with diabetic macular edema from claims data: a validation study.Arch Ophthalmol, vol. 126, no. 7, July 2008, pp. 986–89. Pubmed, doi:10.1001/archopht.126.7.986.
Bearelly S, Mruthyunjaya P, Tzeng JP, Suñer IJ, Shea AM, Lee JT, Kowalski JW, Curtis LH, Schulman KA, Lee PP. Identification of patients with diabetic macular edema from claims data: a validation study. Arch Ophthalmol. 2008 Jul;126(7):986–989.

Published In

Arch Ophthalmol

DOI

EISSN

1538-3601

Publication Date

July 2008

Volume

126

Issue

7

Start / End Page

986 / 989

Location

United States

Related Subject Headings

  • United States
  • Sensitivity and Specificity
  • Pilot Projects
  • Ophthalmology & Optometry
  • Macular Edema
  • International Classification of Diseases
  • Insurance Claim Review
  • Humans
  • Health Services Research
  • Diabetic Retinopathy