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Validation of current procedural terminology codes for rotavirus vaccination among infants in two commercially insured US populations
Author(s) -
Hoffman Veena,
Everage Nicholas J.,
Quinlan Scott C.,
Skerry Kathleen,
Esposito Daina,
Praet Nicolas,
Rosillon Dominique,
Holick Crystal N.,
Dore David D.
Publication year - 2016
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4085
Subject(s) - current procedural terminology , medical record , medicine , reimbursement , vaccination , rotavirus vaccine , rotavirus , diagnosis code , pediatrics , truth value , electronic health record , virology , computer science , diarrhea , health care , surgery , population , environmental health , law , political science , programming language
Abstract Purpose We validated procedure codes used in health insurance claims for reimbursement of rotavirus vaccination by comparing claims for monovalent live‐attenuated human rotavirus vaccine (RV1) and live, oral pentavalent rotavirus vaccine (RV5) to medical records. Methods Using administrative data from two commercially insured United States populations, we randomly sampled vaccination claims for RV1 and RV5 from a cohort of infants aged less than 1 year from an ongoing post‐licensure safety study of rotavirus vaccines. The codes for RV1 and RV5 found in claims were confirmed through medical record review. The positive predictive value (PPV) of the Current Procedural Terminology codes for RV1 and RV5 was calculated as the number of medical record‐confirmed vaccinations divided by the number of medical records obtained. Results Medical record review confirmed 92 of 104 RV1 vaccination claims (PPV: 88.5%; 95% CI: 80.7–93.9%) and 98 of 113 RV5 vaccination claims (PPV: 86.7%; 95% CI: 79.1–92.4%). Among the 217 medical records abstracted, only three (1.4%) of vaccinations were misclassified in claims—all were RV5 misclassified as RV1. The medical records corresponding to 9 RV1 and 15 RV5 claims contained insufficient information to classify the type of rotavirus vaccine. Conclusions Misclassification of rotavirus vaccines is infrequent within claims. The PPVs reported here are conservative estimates as those with insufficient information in the medical records were assumed to be incorrectly coded in the claims. Copyright © 2016 John Wiley & Sons, Ltd.