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

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 s 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.