Identifying neonatal intensive care (NICU) admissions using administrative claims data

Article type: Research Article

Authors: Vance, A.J.^{a; b; *} | Bell, S.^c | Tilea, A.^c | Beck, D.^d | Tabb, K.M.^e | Zivin, K.^{f; g; h}

Affiliations: [a] Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA | [b] College of Nursing, Michigan State University, East Lansing, MI, USA | [c] Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA | [d] UCLA School of Nursing, Los Angeles, CA, USA | [e] University of Illinois at Urbana-Champaign, School of Social Work, Urbana, IL, USA | [f] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA | [g] Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA | [h] Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

Correspondence: [*] Address for correspondence: Ashlee J. Vance, Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA. Tel.: +1 313 799 7225; E-mail: avance2@hfhs.org.

Abstract: BACKGROUND:To define a method for identifying neonatal intensive care unit (NICU) admissions using administrative claims data. METHODS:This was a retrospective cohort study using claims from Optum’s de-identified Clinformatics® Data Mart Database (CDM) from 2016 –2020. We developed a definition to identify NICU admissions using a list of codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and revenue codes frequently associated with NICU admissions. We compared agreement between codes using Kappa statistics and calculated positive predictive values (PPV) and 95% confidence intervals (CI). RESULTS:On average, revenue codes (3.3%) alone identified more NICU hospitalizations compared to CPT codes alone (1.5%), whereas the use of CPT and revenue (8.9%) and CPT or revenue codes (13.7%) captured the most NICU hospitalizations, which aligns with rates of preterm birth. Gestational age alone (4.2%) and birthweight codes alone (2.0%) identified the least number of potential NICU hospitalizations. Setting CPT codes as the standard and revenue codes as the “test,”, revenue codes resulted in identifying 86% of NICU admissions (sensitivity) and 97% of non-NICU admissions (specificity). CONCLUSIONS:Using administrative data, we developed a robust definition for identifying neonatal admissions. The identified definition of NICU codes is easily adaptable, repeatable, and flexible for use in other datasets.

Keywords: Claims data, infant, neonatal intensive care unit, validation

DOI: 10.3233/NPM-230014

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 4, pp. 709-716, 2023