Administrative Billing Codes Accurately Identify Occurrence of Electrical Cardioversion and Ablation/Maze Procedures in Atrial Fibrillation Patients.

Introduction: Administrative billing codes for electrical cardioversion and ablation/maze procedures may be useful for research on atrial fibrillation (AF) progression and treatment if the codes are sufficiently accurate relative to medical record documentation. Hypothesis: We hypothesized that administrative billing codes for electrical cardioversion and ablation/maze procedures would accurately identify the occurrence of those procedures. Methods: We studied adults ages 30-84 years who experienced new onset AF between 10/2001 and 12/2004, and were patients in Group Health, an integrated healthcare system in Washington state. Using medical record review as the gold standard, we assessed the accuracy of administrative billing codes for detecting the occurrence of electrical cardioversion and ablation/maze procedures. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each billing code separately, and collectively for each procedure. Results: Of 1953 study participants with new onset AF, during a mean of 1.5 (SD 0.7) years of follow-up after AF onset, 470 (24%) experienced electrical cardioversion and 44 (2%) experienced ablation/maze procedures according to medical records. For cardioversion, CPT code 92960 performed better than ICD-9 codes 99.61 and 99.62, with higher sensitivity, PPV, and NPV, but slightly lower specificity. For ablation/maze, CPT code 93651 and ICD-9 code 37.34 performed identically, yielding higher sensitivity and PPV than ICD-9 code 37.33. For cardioversion and ablation/maze procedures, combining three codes improved sensitivity and NPV while maintaining high specificity and PPV relative to individual codes. (See Table.) Conclusions: Administrative billing data accurately identify electrical cardioversion and ablation/maze procedures, and can be used in place of medical record review. Our findings apply to integrated health systems or other settings where administrative billing databases are available. [ABSTRACT FROM AUTHOR]