Claims_Codes: Medicare and Medicaid Long-Term Opioid Therapy Data, 2016–2022

65.5 million Medicaid and 59.6 million Medicare beneficiary records from 2016–2022 were used to assess the validity of diagnostic codes for identifying long-term opioid therapy. The dataset, created by Robert W. Hurley and last updated in April 2026, compares prescription-based and code-based identification methods and their association with adverse outcomes like opioid use disorder and mortality. Results show diagnostic code Z79.891 had a sensitivity of 30.5% in Medicaid and 34.6% in Medicare against the prescription-based reference standard.

Use Cases

• Validate diagnostic code Z79.891 against prescription-based definitions for long-term opioid therapy using sensitivity and specificity metrics.
• Compare risk profiles for opioid use disorder and mortality between patients identified by prescription-based versus code-based methods.
• Analyze associations between long-term opioid therapy identification methods and outcomes like emergency department visits for pain.
• Assess the criterion validity of administrative data for population health surveillance of opioid therapy.

Strengths

• Uses 100% Medicare and Medicaid claims data, covering 65.5 million Medicaid and 59.6 million Medicare beneficiaries.
• Provides specific criterion validity metrics (e.g., sensitivity 30.5%, PPV 40.2%) for diagnostic code Z79.891.
• Compares risk profiles across two large, distinct insurance populations (Medicare and Medicaid).
• Covers a seven-year time range from 2016 to 2022.

Limitations

• Column-level documentation is absent; field semantics must be inferred after download.
• Row count for the primary dataset is unknown, which may limit suitability assessment.
• Data is specific to U.S. Medicare and Medicaid populations, which may limit generalizability.

Provenance

Source

100% Medicare and Medicaid claims data.

Collection Method

Retrospective cohort study.

Time Range

2016–2022

Freshness

Last updated 2026-04-29 17:36:03; freshness should be verified.

Geography

United States (Medicare and Medicaid populations).