Zeenat Qureshi Stroke Research Center, University of Minnesota Medical Center, Minneapolis, MN, USA.
J Stroke Cerebrovasc Dis. 2012 Feb;21(2):121-3. doi: 10.1016/j.jstrokecerebrovasdis.2010.05.011. Epub 2010 Sep 19.
A new International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code, V45.88, was approved by the Centers for Medicare and Medicaid Services (CMS) on October 1, 2008. This code identifies patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated in one hospital's emergency department, followed by transfer within 24 hours to a comprehensive stroke center, a paradigm commonly referred to as "drip-and-ship." This study assessed the use and accuracy of the new V45.88 code for identifying ischemic stroke patients who meet the criteria for drip-and-ship at 2 advanced certified primary stroke centers. Consecutive patients over a 12-month period were identified by primary ICD-9-CM diagnosis codes related to ischemic stroke. The accuracy of V45.88 code utilization using administrative data provided by Health Information Management Services was assessed through a comparison with data collected in prospective stroke registries maintained at each hospital by a trained abstractor. Out of a total of 428 patients discharged from both hospitals with a diagnosis of ischemic stroke, 37 patients were given ICD-9-CM code V45.88. The internally validated data from the prospective stroke database demonstrated that a total of 40 patients met the criteria for drip-and-ship. A concurrent comparison found that 92% (sensitivity) of the patients treated with drip-and-ship were coded with V45.88. None of the non-drip-and-ship stroke cases received the V45.88 code (100% specificity). The new ICD-9-CM code for drip-and-ship appears to have high specificity and sensitivity, allowing effective data collection by the CMS.
一个新的国际疾病分类，第九修订版，临床修正（ICD-9-CM）诊断代码，V45.88，于 2008 年 10 月 1 日被医疗保险和医疗补助服务中心（CMS）批准。这个代码确定了在一个医院的急诊室接受静脉内（IV）重组组织纤溶酶原激活物（rt-PA）治疗的患者，随后在 24 小时内转移到一个综合性卒中中心，这是一种通常被称为“滴注和转运”的模式。本研究评估了新的 V45.88 代码在识别符合滴注和转运标准的缺血性卒中患者中的使用和准确性，这是在两个先进的认证初级卒中中心进行的。在 12 个月的时间里，通过与缺血性卒中相关的主要 ICD-9-CM 诊断代码连续识别患者。通过与每个医院由经过培训的摘要员维护的前瞻性卒中登记处收集的数据进行比较，评估了通过健康信息管理服务提供的行政数据利用 V45.88 代码的准确性。在两家医院出院的总共 428 名缺血性卒中患者中，有 37 名患者被给予 ICD-9-CM 代码 V45.88。前瞻性卒中数据库的内部验证数据表明，共有 40 名患者符合滴注和转运标准。同时进行的比较发现，接受滴注和转运治疗的患者中有 92%（敏感性）被编码为 V45.88。没有非滴注和转运的卒中病例接受 V45.88 编码（特异性为 100%）。新的用于滴注和转运的 ICD-9-CM 代码似乎具有很高的特异性和敏感性，允许 CMS 进行有效的数据收集。
