VALIDITY OF AKI DIAGNOSIS AMONG PATIENTS UNDERGOING PCI: DISCHARGE NOTES VERSUS BILLING CODES

W-Y KUO1, M-Y JIANG1
1Chi Mei Medical Center, Tainan, Taiwan

Aim: The objective of this study was to explore the physicians’ recognition rate of acute kidney injury (AKI) and validity of billing code-identified AKI among patients undergoing percutaneous coronary intervention (PCI).
Background: PCI is associated with higher risk to develop AKI. There had been several studies to examine the occurrence of AKI after PCI, either using creatinine-based method or AKI billing codes to identify patients with AKI. However, AKI was frequently under-recognized and was even more under-reported in administrative database.
Methods: We retrospectively reviewed the medical records of 1,175 patients undergoing PCIs at a tertiary care center. AKI and severe AKI were the reference standards, which were defined as an absolute increase of ≥ 0.3 mg/dL or ≥ 1.5-fold relative increase, and as ≥ 2-fold increase between baseline and post-procedural serum creatinine. We compared discharge diagnosis and billing code-identified AKI against the predefined reference standards of AKI to measure the validity of AKI diagnosis.
Results: The physicians’ recognition rate of AKI among patients who developed AKI and severe AKI after PCI were 30.98% (57/184) and 52.63% (40/76), respectively. The positive predictive value, negative predictive value, and specificity of discharge diagnosis of AKI were 68.76% & 48.19%, 88.37% & 96.70%, and 97.38% & 96.09% in patients with AKI & severe AKI after PCI. Billing code-identified AKI showed a high specificity (98.18% and 97.54%, respectively), intermediate positive predictive value (66.04% and 49.06%, respectively), but low sensitivity (19.02% and 34.21%, respectively) in patients with AKI and severe AKI after PCI.
Conclusions: AKI was under-recognized, even in more severe form of illness. Billing codes of claim data also appear to miss many patients with AKI after PCI.


Biography:
Dr. Ming-Yan Jiang is a nephrologist with 6-year working experience in nephrology division of Chi Mei Medical Center. He obtained the degree of Doctor of Medicine from Kaohsiung Medical University, Taiwan. He achieved the Master Degree in Public Health from College of Medicine, National Cheng Kung University, Tainan, Taiwan. The research interests include acute kidney injury, chronic kidney disease and end stage renal disease.

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