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The validity of hospital diagnostic and procedure codes reflecting morbidity in preterm neonates born <32 weeks gestation

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Abstract

Objective

To determine the validity of diagnostic hospital billing codes for complications of prematurity in neonates <32 weeks gestation.

Study Design

Retrospective cohort data from discharge summaries and clinical notes (n = 160) were reviewed by trained, blinded abstractors for the presence of intraventricular hemorrhage (IVH) grades 3 or 4, periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), stage 3 or higher, retinopathy of prematurity (ROP), and surgery for NEC or ROP. Data were compared to diagnostic billing codes from the neonatal electronic health record.

Results

IVH, PVL, ROP and ROP surgery had strong positive predictive values (PPV > 75%) and excellent negative predictive values (NPV > 95%). The PPVs for NEC (66.7%) and NEC surgery (37.1%) were low.

Conclusion

Diagnostic hospital billing codes were observed to be a valid metric to evaluate preterm neonatal morbidities and surgeries except in the instance of more ambiguous diagnoses such as NEC and NEC surgery.

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Data availability

Data used in the creation of the dataset contains potentially sensitive information and restrictions on sharing of this information is managed by the University of Iowa’s Institutional Review Board. The institutional point of contact for data request for this study is Nancy Weathers (Nancy-weathers@uiowa.edu).

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Acknowledgements

We would like to thank Amy Castonguay and Allison Momany for their early work in developing the medical record validation protocols that eventually led to this work. We would also like to thank the Institute for Clinical and Translational Science (ICTS) Bioinformatics Core at the University of Iowa for creating the data repository used for this study. They were supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537.

Funding

This research was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD102381). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Iowa, Iowa City, IA, USA

    Kelli K. Ryckman, Paul J. Holdefer, Eva Sileo, Claire Carlson & Nancy Weathers

  2. Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA

    Kelli K. Ryckman

  3. Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA

    Paul J. Holdefer

  4. Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA

    Elizabeth A. Jasper

  5. Center for Precision Medicine, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA

    Elizabeth A. Jasper

  6. Department of Biostatistics, University of Iowa, Iowa City, IA, USA

    Hyunkeun Cho

  7. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Scott P. Oltman & Laura L. Jelliffe-Pawlowski

  8. UCSF California Preterm Birth Initiative, San Francisco, CA, USA

    Scott P. Oltman, Laura L. Jelliffe-Pawlowski & Elizabeth E. Rogers

  9. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    John M. Dagle

  10. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Elizabeth E. Rogers

Authors
  1. Kelli K. Ryckman
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Contributions

K.K.R. designed the study, performed statistical analysis, co-drafted the manuscript; P.J.H. co-drafted the manuscript; E.S., C.C., and N.W. collected data and provided critical input to the final draft of the manuscript. E.A.J., H.C., S.P.O., J.M.D., L.L.P., and E.E.R. assisted with conceptualization of the study and provided critical input to the final draft of the manuscript.

Corresponding author

Correspondence to Kelli K. Ryckman.

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Ryckman, K.K., Holdefer, P.J., Sileo, E. et al. The validity of hospital diagnostic and procedure codes reflecting morbidity in preterm neonates born <32 weeks gestation. J Perinatol 43, 1374–1378 (2023). https://doi.org/10.1038/s41372-023-01685-6

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