Validating prolonged time in cpt coding

11-Nov-2014 15:18 by 10 Comments

Validating prolonged time in cpt coding

In contrast to commercial claims data sources, Medicare has a large number of patients over the age of 65 years, when incidence and prevalence of AF begin to increase dramatically.The analysis used fee-for-service (FFS), nondisabled Medicare patients who were not eligible for Medicaid.

The number of matches were allowed to differ for each patient with an event, since varying numbers of controls have been shown to reduce bias [18].

While numerous studies have estimated direct and indirect costs of stroke and bleeding outcomes among AF patients in the first year following the event [9–11], long-term US cost estimates have generally relied on modeling techniques extrapolating available data covering a shorter period of time.

Lifetime and other long-term cost modeling estimates would be expected to be more accurate if based on data covering a period of time extended beyond 1 year [12].

Patients with evidence of valvular conditions during the baseline period or quarter of AF diagnosis (codes in Table 1) were excluded.

Because the stage of NVAF disease progression has an impact on medical utilization (e.g., newly diagnosed patients tend to have higher costs than prevalent patients), the study was limited to patients with incident NVAF, defined as no AF claims during the baseline period, to allow patients to be matched on duration of NVAF.

Patients were followed from the first occurrence of ischemic stroke, major bleeding, or intracranial hemorrhage (ICH) resulting in hospitalization.

Those with events were matched with 1–5 NVAF patients without events.The data did not include prescription claims; therefore, warfarin therapy was inferred for patients with at least 3 prothrombin tests (ICD-9 codes V58.61, CPT codes 85610, 85611, 99363, and 99364) during a 1-year period after NVAF diagnosis.This methodology has been validated previously in the Medicare data with 89% sensitivity and 92% specificity [6].The files contain final action claims with all adjustments resolved for a 5% sample of all Medicare beneficiaries in each calendar year, including inpatient, outpatient, emergency room (ER), skilled nursing facility (SNF), hospice, home health agency, durable medical equipment (DME), and carrier (formerly Part B physician/supplier) claims.As this study was a retrospective analysis of existing, deidentified claims data, an institutional review board evaluation was not applicable and therefore, not conducted.Atrial fibrillation (AF) affects more than 3 million Americans and is characterized by an irregularly irregular heart rhythm, often with a rapid heart rate that may result in blood clots, shortness of breath, and overall weakness [1].