Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration.
Shelli L Feder, Nancy S Redeker, Sangchoon Jeon and 8 others
PMID 29254358WHAT IT FOUND
The ICD-9 code V66.7 accurately identifies specialist palliative care in hospitalized heart failure patients within the Veterans Health Administration.
It missed only one of fifty coded cases and falsely labeled only nine of fifty uncoded cases as lacking care.
Key findings
01The ICD-9 code V66.7 had a positive predictive value of 98% and a negative predictive value of 82% for identifying specialist palliative care.
02The sensitivity of the code was 84% and the specificity was 98% when compared to electronic health record reviews.
03Goals of care discussions were the primary reason for specialist palliative care consultation in 43% of cases.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was 100% male and younger than typical heart failure cohorts, limiting generalizability to women or older adults. The study assumed that if specialist palliative care was provided, it was documented in the electronic health record; undocumented care would bias results. The study did not validate the code for identifying primary palliative care delivered by non-specialists, which is often recorded in unstructured notes. The high prevalence of palliative care in the matched sample (50% by design) may overestimate the positive predictive value in settings where palliative care is less common. The validation was specific to the Veterans Health Administration, where coding practices are directed centrally and may differ from other healthcare systems.
Declared interests
The authors report no competing financial interests.
The easy way to misread this
Do not assume this code accurately captures palliative care delivered by non-specialists, such as primary teams managing symptoms or discussing goals, as the study only validated its ability to identify specialist palliative care consultations and unit admissions.