Abstract
Background
Administrative procedure code data can estimate colonoscopy utilization; however, determining colonoscopy indication is more difficult as procedure codes do not inherently reflect the purpose (screening, surveillance, diagnosis) of the colonoscopy.
Aim
To improve the reported sensitivity (70%) and specificity (72%) of a published algorithm for identifying screening colonoscopies using Veterans Health Administration (VHA) administrative data.
Methods
We validated three algorithms for determining colonoscopy indication using medical records as the gold standard in a national sample of 650 patients. Algorithms used International Classification of Diseases, 9th Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Medical records were manually abstracted using standardized protocols.
Results
The best algorithm had 83% sensitivity and 76% specificity for screening indication. Over 99% of colonoscopy CPT codes corresponded to a colonoscopy in the medical record.
Conclusions
VHA procedure codes are very accurate for colonoscopy utilization; however, algorithms to ascertain indication have only moderate accuracy.
Similar content being viewed by others
References
Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004;127(6):1670–1677.
Centers for Disease Control and Prevention. Use of colorectal cancer tests—United States, 2002, 2004, and 2006. Morbidity and Mortality Weekly Report, CDC, Atlanta, GA. 2008 March 14; 57(10):253–258.
Mysliwiec PA, Brown ML, Klabunde CN. Ransohoff DF: are physicians doing too much colonoscopy? A national survey of colorectal surveillance after polypectomy. Ann Intern Med. 2004;141:264–271.
Boolchand V, Olds G, Singh J, Singh P, Chak A. Cooper GS: colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Intern Med. 2006;145:654–659.
Walter LC, Lindquist K, Nugent S, et al. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150:465–473.
Haque R, Chiu V, Mehta KR, Geiger AMl. An automated data algorithm to distinguish screening and diagnostic colorectal cancer endoscopy exams. J Natl Cancer Inst Monogr. 2005;35:116–118.
El-Serag HB, Petersen L, Hampel H, Richardson P, Cooper G. The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Arch Intern Med. 2006;166(20):2202–2208.
Schneeweiss S, Wang PS, Avorn J, Glynn RJ. Improved comorbidity adjustment for predicting mortality in medicare populations. Health Serv Res. 2003;38(4):1103–1120.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–1139.
Support
This study was funded by a pilot grant from the VA Colorectal Cancer QUERI (Quality Enhancement Research Initiative). Additional support was from a VA Health Services Research and Development Career Development Transition Award RCD 03-174 (Fisher). The study sponsors had no role in the study design, collection, analysis, interpretation of data, or the writing of this report. The authors have no disclosures.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fisher, D.A., Grubber, J.M., Castor, J.M. et al. Ascertainment of Colonoscopy Indication Using Administrative Data. Dig Dis Sci 55, 1721–1725 (2010). https://doi.org/10.1007/s10620-010-1200-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-010-1200-y