Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA.
Department of Neurology, Harvard Medical School, Boston, MA, USA.
J Neurooncol. 2009 Dec;95(3):427-431. doi: 10.1007/s11060-009-9943-z. Epub 2009 Jun 27.
In this study, we sought to determine the accuracy with which the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis code for "secondary neoplasm of brain and spinal cord" in health insurance claims measures clinically evident central nervous system (CNS) metastases in patients with non-small cell lung cancer (NSCLC). For 241 consecutive patients with newly diagnosed NSCLC, we compared ICD-9-CM "secondary neoplasm" codes indicating tumor spread to the CNS from institutional billing records to gold-standard chart review to determine: (1) sensitivity, specificity and positive predictive value (PPV) of the site-specific secondary neoplasm code and (2) the accuracy in time of its appearance within billing records compared with the gold standard date of CNS relapse. The occurrence of at least one ICD-9-CM code for brain metastasis (Algorithm 1) had a sensitivity of 100% (95% CI: 100-100%) and PPV of 91% (95% CI: 87-94%). By requiring >or= 2 codes (Algorithm 2) or >or= 3 codes (Algorithm 3) for the diagnosis of brain metastasis in claims, specificity and PPV improved, while sensitivity did not drop substantially. The claims-based date of diagnosis was also accurate, with 92% of dates falling within 30 days of the gold standard. ICD-9-CM codes in institutional billing claims reliably documented NSCLC metastases to the CNS. These results suggest that Medicare claims data may be used to evaluate clinical and epidemiological issues related to brain metastases in elderly cancer patients.
在这项研究中，我们旨在确定医疗保险索赔中使用的国际疾病分类第 9 版临床修订版（ICD-9-CM）诊断代码“脑和脊髓继发肿瘤”用于测量非小细胞肺癌（NSCLC）患者临床明显的中枢神经系统（CNS）转移的准确性。我们对 241 例连续确诊的 NSCLC 患者进行了研究，将 ICD-9-CM“继发肿瘤”代码指示肿瘤向 CNS 扩散的情况与机构计费记录的金标准图表审查进行了比较，以确定：（1）特定部位继发肿瘤代码的敏感性、特异性和阳性预测值（PPV）；（2）与 CNS 复发的金标准日期相比，计费记录中该代码出现的时间准确性。至少有一个脑转移 ICD-9-CM 代码（算法 1）的出现具有 100%的敏感性（95%CI：100-100%）和 91%的 PPV（95%CI：87-94%）。通过在索赔中要求>或=2 个代码（算法 2）或>或=3 个代码（算法 3）来诊断脑转移，特异性和 PPV 提高，而敏感性没有大幅下降。基于索赔的诊断日期也很准确，92%的日期与金标准相差 30 天以内。机构计费索赔中的 ICD-9-CM 代码可靠地记录了 NSCLC 向 CNS 的转移。这些结果表明，医疗保险索赔数据可用于评估与老年癌症患者脑转移相关的临床和流行病学问题。
