Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

66 Maternal Intensive Care in Belgium KCE Reports 94
5.4 TRANSLATION AND VALIDATION OF THE PATHOLOGY
AND RISK FACTORS INTO ICD-9-CM/IMA DATA
The theoretical list was used as a starting point to identify pathologies in the database
described before. During each phase of the construction process (cf. supra), the
theoretical concepts were systematically translated into respectively ATC (Anatomic
Therapeutical Classification) -codes, ICD-9-CM, (International Classification of Diseases
version 9 - Clinical Modification) and RIZIV-INAMI nomenclature. The main structural
work was done by a team of ICD-9 codification experts 49 . An intense collaboration
between the Gent codification experts, IMA experts and the Gent research team was
responsible for the right interpretation of the theoretical indications into the correct
codes. The list of codes was systematically reworked every time the research-group
made adaptations to the theoretical list.
During this translation-process (in close consultation with the obstetricians) it became
clear that specific medication (ATC) given to pregnant women for non pregnancy
related problems were not specific enough to evaluate the severity of illness. The main
focus remained the MKG/RCM codes that can distinguish peripartal women with or
without certain disorders. For most pathology the MKG-code was composed of one or
more disease-codes and a V-code . The code for pregnancy (648.X) was added to each
pathology for not pregnancy related disorders. The pregnancy related pathology has its
own specific codes. When the ICD-9 code (incl. the V-code) was not specific enough,
the combination with additional ATC and RIZIV-INAMI was made.
For the not-pregnancy related pathology, the nuance between pathologies requiring
‘grey zone’ care and intermediate care was difficult to make. The theoretical exercise
appeared very difficult to translate into the available data. For example for ‘severe
nephrologic infections (except pyelonephritis)’ there is no possibility to make the
distinction between severe or not, based on ICD-9, ATC or RIZIV-codes. Malaria (with
systemic symptoms), severe pulmonary infections (incl. complicated pneumonia) and
well controlled epileptic patient (with active medical treatment), are other not
pregnancy related disorders wherefore the distinction between severe or less severe
was not possible.
Other theoretical concepts could not be translated into codes e.g.: with or without
positive thyroid antibodies, in consultation with a diabetologist, creatinine > 1,5 mg/dl,
with suspected or confirmed foetal anomalies, with maternal clinical symptoms and
foetal anomalies, > 5 units alcohol a day and severe drug abuse.
All disorders, with pre-existing medical problems, in relation to pregnancy and
postpartum generated difficulties. An enormous amount of medication, treatments and
variations of severity in relation to pregnancy was encountered. For the pregnancyrelated
and foetal problems there was less discussion, nevertheless the listed specific
problems of the peripartum were relatively difficult to code.
The final coded list of admission criteria was verified and corrected by two other
MKG/RCM codification experts 50 . When experts had a different opinion, codes were
discussed with the researchers and adaptations were made.
49 Dr. E. Baert & Ms. Van Coppenolle of the Gent University Hospital
50 namely one from the KULeuven and one from the ULG