TABLE 2. Sensitivity, specificity, positive predictive value, and negative predictive value of reported International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) codes compared with confirmed cases of substance-exposed newborns and infants with neonatal abstinence syndrome caused by in utero exposures to various substance groups, by type of controlled substance — 15 Massachusetts hospitals, 2017.
| ICD-10-CM code | Validation measure | Substance-exposed newborns and infants with NAS, % (95% CI)* |
||
|---|---|---|---|---|
| Opioids | Opioids or benzodiazepines | Opioids, benzodiazepines, barbiturates, marijuana, amphetamines, cocaine, or hallucinogens | ||
|
Substance-exposed newborns
| ||||
| F11.20 or F13.20† |
Sensitivity |
41.4 (28.1–54.8) |
30.9 (20.7–41.0) |
16.3 (11.6–21.0) |
| Specificity |
100.0 (100.0–100.0) |
100.0 (100.0–100.0) |
100.0 (100.0–100.0) |
|
| PPV |
98.6 (96.9–100.0) |
98.9 (97.3–100.0) |
98.9 (97.3–100.0) |
|
| NPV |
98.5 (97.6–99.3) |
97.5 (96.4–98.6) |
94.4 (92.7–96.1) |
|
| P04.49 or P96.1† |
Sensitivity |
60.5 (41.7–79.3) |
45.7 (31.2–60.2) |
30.9 (22.5–39.2) |
| Specificity |
99.4 (99.3–99.5) |
99.5 (99.3–99.6) |
99.9 (99.9–100.0) |
|
| PPV |
73.9 (69.6–78.3) |
75.2 (70.9–79.5) |
96.0 (94.1–98.0) |
|
| NPV |
98.9 (98.1–99.8) |
98.1 (96.9–99.2) |
95.3 (93.6–97.0) |
|
|
Infants with neonatal abstinence syndrome
| ||||
| P04.49 or P96.1† |
Sensitivity |
92.1 (88.8–95.5) |
92.2 (88.9–95.5) |
92.3 (89.0–95.5) |
| Specificity |
99.2 (99.1–99.4) |
99.2 (99.1–99.4) |
99.2 (99.1–99.4) |
|
| PPV |
63.9 (59.1–68.6) |
64.3 (59.6–69.1) |
65.0 (60.3–69.7) |
|
| NPV |
99.9 (99.8–99.9) |
99.9 (99.8–99.9) |
99.9 (99.8–99.9) |
|
| P96.1†,§ | Sensitivity |
80.2 (74.3–86.1) |
79.8 (73.9–85.7) |
79.4 (73.5–85.3) |
| Specificity |
99.9 (99.8–99.9) |
99.9 (99.8–99.9) |
99.9 (99.8–99.9) |
|
| PPV |
91.7 (87.9–95.5) |
92.0 (88.3–95.7) |
92.3 (88.6–96.0) |
|
| NPV | 99.7 (99.6–99.8) | 99.7 (99.6–99.8) | 99.7 (99.6–99.8) | |
Abbreviations: CI = confidence interval; NAS = neonatal abstinence syndrome; NPV = negative predictive value; PPV = positive predictive value.
* Percentages use weighted data.
† F11.20: opioid dependence, uncomplicated; F13.20: sedative, hypnotic, or anxiolytic dependence, uncomplicated; P04.49: newborn affected by maternal use of other drugs of addiction; and P96.1: neonatal withdrawal symptoms from maternal use of drugs of addiction.
§ Weighted data from 12 of 15 selected hospitals that reported individual ICD-10-CM diagnostic codes (representing 69.5% of total weighted sample).