Digestive Diseases and Sciences

, Volume 55, Issue 9, pp 2592–2598 | Cite as

Validation of ICD-9-CM Diagnostic Codes for Inflammatory Bowel Disease Among Veterans

  • Selvi Thirumurthi
  • Reezwana Chowdhury
  • Peter Richardson
  • Neena S. Abraham
Original Article



Inflammatory bowel disease (IBD) is well described among young whites and less so among the elderly and non-whites. Population-level data is required to assess outcomes among minority groups.


To validate diagnostic codes for IBD from the Department of Veterans Affairs.


National databases were used to identify local patients with Crohn’s disease (CD) and ulcerative colitis (UC), the extra-intestinal manifestations and surgical procedures associated with IBD. Diagnosis was confirmed by manual chart abstraction. Multivariable logistic regression was used to derive diagnostic algorithms for CD and UC, which were then validated in an independent cohort.


The test cohort of 3,827 patients (1,316 potential cases, 2,511 random controls) was predominantly male (94%), white (56%), and of age of 58 (standard deviation 15). The positive predictive value (PPV) of CD codes was superior (88–100%) to UC (50–93%). The accuracy of extra-intestinal manifestations and surgeries was poor (PPV 0–29%). ICD-9-CM code 555.x without 560.9 had a PPV of 91% for CD in the validation cohort. Code 556.x with age, gender, and race factors was highly predictive of UC (c-statistic 0.9, PPV of 81%).


VA administrative data can diagnose elderly and non-white patients with IBD.


ICD-9-CM code Ulcerative colitis Crohn’s disease Validation studies Veterans Elderly Positive predictive value 



Department of Veterans Affairs


Patient treatment file


Outpatient care file


Veterans Affairs Pharmacy Benefits Management


Beneficiary identification and records locator subsystem death file


Michael E. DeBakey VA Medical Center


Inflammatory bowel disease


Ulcerative colitis


Crohn’s disease


Current procedural terminology


International classification of diseases, ninth revision, clinical modification


Standard deviation


Positive predictive value


Confidence interval


  1. 1.
    Ananthakrishnan AN, McGinley EL, Binion DG. Inflammatory bowel disease in the elderly is associated with worse outcomes: a national study of hospitalizations. Inflamm Bowel Dis. 2009;15:182–189.CrossRefPubMedGoogle Scholar
  2. 2.
    Robertson DJ, Grimm IS. Inflammatory bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:409–426.CrossRefPubMedGoogle Scholar
  3. 3.
    US Census Bureau. Census 2008. Available at www.census.gov; 2000.
  4. 4.
    Loftus EV Jr. Crohn’s disease: Why the disparity in mortality? Gut. 2006;55:447–449.CrossRefPubMedGoogle Scholar
  5. 5.
    Admin Minnesota. Census 2009. Available at www.lmic.state.mn.us; 2009.
  6. 6.
    Lapidus A. The changing epidemiology of inflammatory bowel diseases. Acta Gastroenterol Belg. 2001;64:155–159.PubMedGoogle Scholar
  7. 7.
    Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–1168.CrossRefPubMedGoogle Scholar
  8. 8.
    Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut. 2000;46:336–343.CrossRefPubMedGoogle Scholar
  9. 9.
    Munkholm P, Langholz E, Nielsen OH, Kreiner S, Binder V. Incidence and prevalence of Crohn’s disease in the county of Copenhagen, 1962–87: a sixfold increase in incidence. Scand J Gastroenterol. 1992;27:609–614.CrossRefPubMedGoogle Scholar
  10. 10.
    VA general info website. Washington, D C: Department of Veterans Affairs 2008. Available at http://www1.va.gov; 2008.
  11. 11.
    Abraham NS, El-Serag HB, Johnson ML, et al. National adherence to evidence-based guidelines for the prescription of nonsteroidal anti-inflammatory drugs. Gastroenterology. 2005;129:1171–1178.CrossRefPubMedGoogle Scholar
  12. 12.
    Thirumurthi S, Desilva R, Castillo DL, Richardson P, Abraham NS. Identification of Helicobacter pylori infected patients, using administrative data. Aliment Pharmacol Ther. 2008;28:1309–1316.CrossRefPubMedGoogle Scholar
  13. 13.
    Chaudhuri A, Stenger H. Survey sampling: theory and methods. 2nd ed. Boca Raton, FL: CRC Press; 2005.Google Scholar
  14. 14.
    Herrinton LJ, Liu L, Lafata JE, et al. Estimation of the period prevalence of inflammatory bowel disease among nine health plans using computerized diagnoses and outpatient pharmacy dispensings. Inflamm Bowel Dis. 2007;13:451–461.CrossRefPubMedGoogle Scholar
  15. 15.
    Murray-Garcia JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP Jr. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000;38:300–310.CrossRefPubMedGoogle Scholar
  16. 16.
    Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province: a population-based study. Am J Epidemiol. 1999;149:916–924.PubMedGoogle Scholar
  17. 17.
    Abreu MT, Harpaz N. Diagnosis of colitis: making the initial diagnosis. Clin Gastroenterol Hepatol. 2007;5:295–301.CrossRefPubMedGoogle Scholar
  18. 18.
    Veloso FT, Carvalho J, Magro F. Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol. 1996;23:29–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Kashner TM. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36:1324–1336.CrossRefPubMedGoogle Scholar
  20. 20.
    Kramer JR, Davila JA, Miller ED, Richardson P, Giordano TP, El-Serag HB. The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther. 2008;27:274–282.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Selvi Thirumurthi
    • 1
    • 4
  • Reezwana Chowdhury
    • 4
  • Peter Richardson
    • 1
    • 2
  • Neena S. Abraham
    • 1
    • 2
    • 3
    • 4
  1. 1.Section of Health Services ResearchHouston Center for Quality of Care & Utilization StudiesHoustonUSA
  2. 2.The Gastrointestinal Outcomes in Geriatrics (GO-GERI) UnitMichael E. DeBakey Veterans Affairs Medical CenterHoustonUSA
  3. 3.Section of Digestive DiseasesMichael E. DeBakey Veterans Affairs Medical CenterHoustonUSA
  4. 4.Department of Medicine, Gastroenterology and Hepatology DivisionBaylor College of MedicineHoustonUSA

Personalised recommendations