Accuracy of Administrative Coding for Type 2 Diabetes in Children, Adolescents, and Young Adults

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Abstract
Administrative data are used with increasing frequency in research. However, validity of such data, including International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes (1), varies across diseases and settings (2–12). The ICD-9-CM coding for diabetes in youth may be especially susceptible to errors. While most diagnoses of diabetes in American youth are type 1 diabetes (13), incidence of type 2 diabetes is increasing (14). Rising prevalence of pediatric obesity (15) makes distinguishing between type 1 and type 2 diabetes at diagnosis difficult, and type 2 diabetes ICD-9-CM codes (250.X0/X2) include “unspecified” diabetes (1). Our aim was to evaluate the positive predictive value (PPV) of type 2 diabetes ICD-9-CM codes in children, adolescents, and young adults. In a retrospective chart review, we evaluated 432 patients aged <26 years as of 31 January 2005 with at least one visit to the Endocrine/Diabetes or Obesity Programs at Children’s Hospital Boston in Boston, Massachusetts, from 1 July 2003 to 31 January 2005 and at least one type 2 diabetes ICD-9-CM code (250.X0/X2, X = 0–9) from inpatient/outpatient sites before 5 April 2005. We identified 455 patients utilizing scheduling and billing information, and excluded 23 patients without completed visits. To contrast the accuracy of type 2 diabetes ICD-9-CM codes with type 1 diabetes ICD-9-CM codes, we reviewed charts of patients <26 years as of 31 January 2005 with at least one visit to the Endocrine/Diabetes Program from 1 July 2003 to 31 January …