Resumen de Use of International Classification of Diseases, Ninth Revision, Clinical Modification, Codes to Identify Inpatient Fall-Related Injuries

Teresa M. Waters, A. Michelle Chandler, Lorraine Mion, Michael J. Daniels, Lori A. Kessler, Stephen T. Miller, Ronald I. Shorr

• Objectives: To compare falls and fall-related injuries that a fall evaluator or hospital incident report identified with injuries identified according to discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for the same set of inpatient episodes of care.

  Design: Prospective, descriptive study.

  Setting: Sixteen adult general medical and surgical units in a major urban teaching hospital.

  Participants: All adults who sustained a fall with injury during a 5-year period (380 falls with injury).

  Measurements: Falls that a fall evaluator or hospital incident report identified were classified according to their injury severity. Discharge abstracts provided diagnosis codes (ICD-9-CM) for the discharge, including fall-related injury codes.

  Results: Three hundred forty-three inpatient falls with injury (90.2%) resulted in temporary harm to the individual; the remaining 37 falls (9.8%) resulted in more-serious harm. Sixteen of the 37 falls with injury extending hospitalization or resulting in death were identified using Centers for Medicare and Medicaid Services (CMS)-targeted injury code ranges combined with present-on-admission indicators. Of the 21 falls with injury that were not identified, nine (42.9%) lacked documentation of any injury, and seven (33.3%) identified other injuries outside the CMS-targeted injury code ranges.

  Conclusion: The CMS-targeted ICD-9-CM codes used to identify fall-related injuries in claims data do not always detect the most-serious falls.