2017 Articles

Validation of the V66.7 code for palliative care consultation in a single academic medical center

Hua, May; Li, Guohua; Clancy, Caitlin; Morrison, R. Sean; Wunsch, Hannah

Background: Use of administrative data to study the effectiveness of specialized palliative care is limited by the lack of a reliable method to identify patients receiving palliative care consultation. The International Classification of Diseases, Ninth Revision (ICD-9) code V66.7 has been used, but its validity for this purpose is unknown.
Objective: To examine the validity of the ICD-9 code V66.7 for identifying whether hospitalized patients received palliative care consultation.
Design: Retrospective cohort study.
Setting/Subjects: All patients age ≥ 18 years admitted to a single academic medical center between August 2013 and August 2015.
Measurements: Sensitivity and specificity of the V66.7 code for palliative care consultation for all patients and several a priori subgroups. The reference standard was the presence of a palliative care consultation note in the electronic medical record.
Results: Of 100,910 admissions, 1,999 received a palliative care consultation (2.0%) and 1,846 (1.8%) had usage of the V66.7 code. Sensitivity and specificity for the V66.7 code were 49.9% and 99.1% respectively. Sensitivity was considerably higher for certain subgroups, such as patients with dementia (76.3%) and metastatic cancer (66.3%); addition of age restrictions further improved sensitivity while maintaining high specificity. Specificity was substantially lower for patients who died during hospitalization (sensitivity 53.9%, specificity 75.1%).
Conclusions: In a single center, the ICD-9 code V66.7 had poor sensitivity and high specificity for identifying hospitalized patients who received a palliative care consultation. Appropriate use of this code for this purpose should take these characteristics into consideration.