Objectives: This study examined whether clinical evidence in medical records confirms ICD-9-CM diagnoses that identify the Patient Safety Indicator (PSI) accidental puncture or laceration (APL), and examined the utility of procedure codes in identifying patients who suffered an APL. Methods: Validation results were based on a retrospective medical record review of 67 inpatients from the year 2000 in New York State with ICD-9-CM codes corresponding to APL. Secondary procedure codes of New York inpatients during 2001 were examined to identify patients suffering punctures and lacerations who were not captured by the PSI. Results: Clinical conditions represented by ICD-9-CM codes used in the PSI were frequently not present in the records of the 67 patients. Cases of APL that were missed by the PSI were identified using procedure codes. Conclusions: Not all of the patients identified by the PSI meet the intent of the indicator. The PSI also misses cases of APL by failing to use procedure codes in the algorithm.