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Am J Hosp Palliat Care. 2018 Jul;35(7):959-965. doi: 10.1177/1049909117747519. Epub 2017 Dec 18.

Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration.

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1 Yale School of Nursing, Yale University West Campus, West Haven, CT, USA.
2 VA Connecticut Healthcare System, West Haven, CT, USA.
3 Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
4 Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
5 Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
6 Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
7 Department of Medicine, Yale School of Medicine, New Haven, CT, USA.



Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision ( ICD-9) code, V66.7, can identify palliative care services. However, code validity for specialist palliative care in the Veterans Health Administration (VHA) has not been determined.


To validate the ICD-9 code for specialist palliative care and determine common reasons for specialist palliative care consultation among VHA patients hospitalized with HF.


Electronic health record review of data from the Veterans Aging Cohort Study.


The sample included 100 patients hospitalized with HF from 2003 to 2012.


Data from 50 patients with V66.7 were matched by age, race, site of care, hospital length of stay, intensive care unit admission, and fiscal year of study discharge to 50 patients with HF without V66.7 who had died within a year of hospitalization. We calculated positive and negative predictive values (PPV, NPV), sensitivity, and specificity.


All patients included in the sample were male, 66% black ethnicity, and mean age = 65 years (standard deviations [SD] ± 10.5 for cases; SD ± 9.8 for matches). Specialist palliative care was documented for 49 of 50 patients with V66.7 (PPV = 98%, 95% confidence interval [CI]: 88-99) and 9 of 50 patients without the code (NPV = 82%, 95% CI: 68-91). Sensitivity was 84% (95% CI: 72-92), and specificity was 98% (95% CI: 86-99). Establishing goals of care was the most frequent reason for palliative care consultation (43% of the sample).


The ICD-9 code V66.7 identifies specialist palliative care for hospitalized patients with HF in the VHA. Replication of findings in other data sources and populations is needed.


International Classification of Diseases; Ninth Revision (ICD-9) code; heart failure; hospice; hospitalization; palliative care

[Indexed for MEDLINE]

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