Positive predictive value between medical-chart body-mass-index category and obesity versus codes in a claims-data warehouse

AbstractObjective: To evaluate the positive predictive value of claims-based V85 codes for identifying individuals with varying degrees of BMI relative to their measured BMI obtained from medical record abstraction.Methods: This was a retrospective validation study utilizing administrative claims and medical chart data from 1 January 2009 to 31 August 2015. Randomly selected samples of patients enrolled in a Medicare Advantage Prescription Drug (MAPD) or commercial health plan and with a V85 claim were identified. The claims-based BMI category (underweight, normal weight, overweight, obese class I–III) was determined via corresponding V85 codes and compared to the BMI category derived from chart abstracted height, weight and/or BMI. The positive predictive values (PPVs) of the claims-based BMI categories were calculated with the corresponding 95% confidence intervals (CIs).Results: The overall PPVs (95% CIs) in the MAPD and commercial samples were 90.3% (86.3%–94.4%) and 91.1% (87.3%–94.9%), respectively....