Use of ICD-9 coding for estimating the occurrence of cerebrovascular malformations

Abstract

Background and purpose: Accurate epidemiologic data concerning cerebrovascular malformations are scarce. Our goals were to determine the distribution of lesions in the International Classification of Diseases, Ninth Revision, (ICD-9) code for cerebrovascular malformations and to evaluate the use of state discharge registries for estimating their detection rate.

Methods: We reviewed records of all patients discharged from our center between January 1, 1992, and June 30, 1999, whose diagnoses included the ICD-9 code for cerebrovascular anomaly (code 747.81) to determine the accuracy of the coding. Hospital admission rates for cerebrovascular anomaly were calculated by using the 1995-1999 state discharge databases of California and New York.

Results: Of 804 patients with this code, 706 (88%) had a lesion consistent with the diagnosis. Five lesions accounted for 99% of the diagnoses; the two most common were AVM (66%) and cavernous malformation (13%). The ratio of AVMs to all cerebrovascular anomalies was similar to that in a prior population-based study. The sensitivity of identifying a patient with cerebrovascular malformation by using ICD-9 coding was 94%; the false-positive rate was 1.7 cases per 100,000 person-years. For California and New York, rates of first hospital admission for cerebrovascular malformation were 1.5 and 1.8 cases per 100,000 person-years, respectively.

Conclusion: Rates of admission for cerebrovascular malformations calculated from state discharge databases are consistent with disease detection rates in the range of 1 case per 100,000 person-years. However, the false-positive rate for coding is in the same range as the disease detection rate. Thus, current state discharge registries cannot serve as sources of detailed epidemiologic data.

Fig 1.

Subgroups of patients in hospital’s administrative database with the ICD-9 diagnosis of “anomalies of cerebrovascular system,” code 747.81.