ICD-9 Code-Based Venous Thromboembolism Performance Targets Fail to Measure Up

Am J Med Qual. 2016 Sep;31(5):448-53. doi: 10.1177/1062860615583547. Epub 2015 Apr 21.


Venous thromboembolism (VTE) is a common complication among hospitalized patients. Suboptimal prevention practices have prompted payers to consider hospital-associated VTE as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed all cases of hospital-associated VTE at the Johns Hopkins Hospital between July 1, 2010, and June 30, 2011, that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program. Of 157 patients identified as having developed hospital-associated, potentially preventable VTE, only 92 (58.6%) patients developed radiographically confirmed VTE that were potentially preventable. This misclassification of VTE overestimates the marginal additional treatment cost by more than $860 000 and amounts to nearly $200 000 in lost reward in one year alone. ICD-9 codes alone have extremely low positive predictive value to identify true VTE events. The authors recommend linking provision of risk-appropriate prophylaxis to VTE outcomes as a better target for performance improvement.

Keywords: ICD-9; pay for performance; quality improvement; venous thromboembolism.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Female
  • Hospitals / standards*
  • Humans
  • International Classification of Diseases* / standards
  • Male
  • Middle Aged
  • Quality Improvement / standards
  • Quality Indicators, Health Care / standards*
  • Retrospective Studies
  • United States / epidemiology
  • Venous Thromboembolism / classification*
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / epidemiology*
  • Venous Thromboembolism / prevention & control