The Centers for Medicare and Medicaid Healthcare’s Common Procedure Coding System

2021 ◽  
Keyword(s):  
Coding System ◽  
Common Procedure

scholarly journals Reimbursement of Apps for Mental Health: Findings From Interviews

10.2196/14724 ◽  
2019 ◽  
Vol 6 (8) ◽  
pp. e14724 ◽  
Author(s):  
Adam C Powell ◽  
Matthias B Bowman ◽  
Henry T Harbin
Keyword(s):  
Mental Health ◽  
Care Delivery ◽  
Coding System ◽  
Reimbursement Mechanisms ◽  
Common Procedure ◽  
The Us ◽  
Varied Range ◽  
Potential Channels ◽  
Physician Work ◽  
Shed Light

Background Although apps and other digital and mobile health tools are helping improve the mental health of Americans, they are currently being reimbursed through a varied range of means, and most are not being reimbursed by payers at all. Objective The aim of this study was to shed light on the state of app reimbursement. We documented ways in which apps can be reimbursed and surveyed stakeholders to understand current reimbursement practices. Methods Individuals from over a dozen stakeholder organizations in the domains of digital behavioral and mental health, care delivery, and managed care were interviewed. A review of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCSPCS) codes was conducted to determine potential means for reimbursement. Results Interviews and the review of codes revealed that potential channels for app reimbursement include direct payments by employers, providers, patients, and insurers. Insurers are additionally paying for apps using channels originally designed for devices, drugs, and laboratory tests, as well as via value-based payments and CPT and HCSPCS codes. In many cases, it is only possible to meet the requirements of a CPT or HCSPCS code if an app is used in conjunction with human time and services. Conclusions Currently, many apps face significant barriers to reimbursement. CPT codes are not a viable means of providing compensation for the use of all apps, particularly those involving little physician work. In some cases, apps have sought clearance from the US Food and Drug Administration for prescription use as digital therapeutics, a reimbursement mechanism with as yet unproven sustainability. There is a need for simpler, more robust reimbursement mechanisms to cover stand-alone app-based treatments.

scholarly journals Safety of performing transoesophageal echocardiography in patients with oesophageal varices

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011223 ◽  
Author(s):  
Dania Hudhud ◽  
Haytham Allaham ◽  
Mohammad Eniezat ◽  
Tariq Enezate
Keyword(s):  
Heart Diseases ◽  
Transoesophageal Echocardiography ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Oesophageal Perforation ◽  
Oesophageal Varices ◽  
Coding System ◽  
Common Procedure ◽  
Risk Of Rupture ◽  
All Cause Mortality

IntroductionOesophageal varices (EV) are one of the complications of liver cirrhosis that carries a risk of rupture and bleeding. The safety of performing transesophageal echocardiography (TEE) in patients with pre-existing EV is not well described in literature. Therefore, this retrospective study has been conducted to evaluate the safety of preforming TEE in this group of patients.MethodsThe study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System for EV, TEE and in-hospital outcomes. Study endpoints included in-hospital all-cause mortality, hospital length of stay, postprocedural gastrointestinal bleeding and oesophageal perforation.ResultsA total of 81 328 discharges with a diagnosis of EV were identified, among which 242 had a TEE performed during the index hospitalisation. Mean age was 58.3 years, 36.6% female. In comparison to the no-TEE group, the TEE group was associated with comparable in-hospital all-cause mortality (7.0% vs 6.7%, p=0.86) and bleeding (0.9% vs 1.1%, p=0.75); however, TEE group was associated with longer hospital stay (14.9 days vs 6.9 days, p<0.01). There were no reported oesophageal perforations.ConclusionsTEE is not a common procedure performed in patients with pre-existing EV. TEE seems to be a safe diagnostic tool for evaluation of heart diseases in this group of patients.

Risk and cost of anthracycline-induced cardiotoxicity among breast cancer patients in the United States

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1037-1037
Author(s):  
J. C. Choi ◽  
J. D. Chang ◽  
B. Seal ◽  
M. Tangirala ◽  
C. D. Mullins
Keyword(s):  
Breast Cancer ◽  
Index Date ◽  
Breast Cancer Diagnosis ◽  
The United States ◽  
Coding System ◽  
Breast Cancer Patients ◽  
Common Procedure ◽  
Comorbidity Index ◽  
Cohort Groups ◽  
And Control

1037 Background: Onset of anthracycline-induced cardiotoxicity is well documented. However, information regarding the time of onset varies depending on literature. The purpose of this study was to compare the risk of cardiotoxicity among three cohort groups: anthracycline-containing-chemotherapy (ACC), no-anthracycline-containing-chemotherapy (NACC), and no-chemotherapy (control) groups. Methods: A retrospective cohort study was designed using commercial managed care claims database. Adult subjects (≥18) diagnosed with breast cancer, between January 1, 2002 to December 31, 2005, (index-period) were followed for 24 months. Subjects with a previous cardiotoxic events (CE), breast cancer diagnosis, or anthracycline-use 12-months prior to index date were excluded. Index date was the first chemotherapy claim date for ACC and NACC and non-chemotherapy medication claim date for controls. Cohorts were matched by index date and year of birth. CE was defined based on ICD-9-CM and Healthcare Common Procedure Coding System codes. Risk of CE was evaluated using a logistic model with and without adjusting for confounders. Results: 21,106 subjects were classified as ACC (n = 3,428), NACC (n = 7,125), and controls (n = 10,553). NACC cohort was significantly (p < 0.01) older (mean age: 62 years ±12.5) compared to ACC (53±9.7) or control cohorts (59±12.5). ACC cohort had a higher (p < 0.01) average degree of comorbidity, (1.8±0.8) compared to NACC (1.6±0.9) or control (1.3±0.8) as measured by Charlson comorbidity-index. Higher rates of CE were found within the ACC group compared to NACC and controls as early as month 3 post index-date and remained consistent over 24 months. At month 12 post index-date, 14% (n = 485) of ACC and 5% (n = 381) of NACC had CE compared to 3% (n = 310) of controls. After adjusting for all baseline differences, the odds ratio of CE compared to controls was 3.98 (95% CI: 3.27–4.85), and 1.31 (95% CI: 1.11–1.54) for ACC and NACC cohorts, respectively. The total mean costs were $59,287, $20,528, and $11,600, among ACC, NACC, and control cohorts respectively. Conclusions: Compared to NACC and controls, ACC cohorts had significantly higher risk of cardiotoxic events and seen as early as month 3 post treatment initiation. [Table: see text]

scholarly journals Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer

2013 ◽  
Vol 31 (33) ◽  
pp. 4222-4228 ◽  
Author(s):  
Mariana Chavez-MacGregor ◽  
Ning Zhang ◽  
Thomas A. Buchholz ◽  
Yufeng Zhang ◽  
Jiangong Niu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Older Patients ◽  
Cox Proportional Hazards ◽  
Older Age ◽  
Coding System ◽  
Breast Cancer Patients ◽  
Common Procedure ◽  
Factors Associated

Purpose The use of trastuzumab in the adjuvant setting improves outcomes but is associated with cardiotoxicity manifested as congestive heart failure (CHF). The rates and risk factors associated with trastuzumab-related CHF among older patients are unknown. Patients and Methods Breast cancer patients at least 66 years old with full Medicare coverage, diagnosed with stage I-III breast cancer between 2005 and 2009, and treated with chemotherapy were identified in the SEER-Medicare and in the Texas Cancer Registry–Medicare databases. The rates and risk factors associated with CHF were evaluated. Chemotherapy, trastuzumab use, comorbidities, and CHF were identified using International Classification of Diseases, version 9, and Healthcare Common Procedure Coding System codes. Analyses included descriptive statistics and Cox proportional hazards models. Results In total, 9,535 patients were included, of whom 2,203 (23.1%) received trastuzumab. Median age of the entire cohort was 71 years old. Among trastuzumab users, the rate of CHF was 29.4% compared with 18.9% in nontrastuzumab users (P < .001). Trastuzumab users were more likely to develop CHF than nontrastuzumab users (hazard ratio [HR], 1.95; 95% CI, 1.75 to 2.17). Among trastuzumab-treated patients, older age (age > 80 years; HR, 1.53; 95% CI, 1.16 to 2.10), coronary artery disease (HR, 1.82; 95% CI, 1.34 to 2.48), hypertension (HR, 1.24; 95% CI, 1.02 to 1.50), and weekly trastuzumab administration (HR, 1.33; 95% CI, 1.05 to 1.68) increased the risk of CHF. Conclusion In this large cohort of older breast cancer patients, the rates of trastuzumb-related CHF are higher than those reported in clinical trials. Among patients treated with trastuzumab, those with cardiac comorbidities and older age may be at higher risk. Further studies need to confirm the role that the frequency of administration plays in the development of trastuzumab-related CHF.

Effect of podiatric medical care on rates of lower-extremity amputation in a Medicare population

1999 ◽  
Vol 89 (6) ◽  
pp. 312-317 ◽  
Author(s):  
RD Sowell ◽  
WB Mangel ◽  
CJ Kilczewski ◽  
JM Normington
Keyword(s):  
At Risk ◽  
Lower Extremity ◽  
Medical Care ◽  
Health Care Financing ◽  
Lower Extremity Amputation ◽  
Coding System ◽  
Common Procedure ◽  
Medicare Part B ◽  
Patients At Risk ◽  
Extremity Amputation

The purpose of this study was to determine whether Medicare patients at risk for lower-extremity amputation due to complications from diabetes, peripheral vascular disease, and/or gangrene who receive the services classified under Level II code M0101 of the Health Care Financing Administration's Common Procedure Coding System (cutting or removal of corns, calluses, and/or trimming of nails, application of skin creams and other hygienic and preventive maintenance care) have lower rates of lower-extremity amputation than those who do not receive such services. Analysis of the data suggests that those at-risk beneficiaries who received these services were nearly four times less likely to experience lower-extremity amputation than those who did not receive such services. The study has both methodologic limitations (the study considers only one variable, receipt or nonreceipt of certain types of podiatric medical care, while other variables may affect rates of lower-extremity amputation) and technological limitations (attempts to link the 2 years of per case Medicare Part B data were unsuccessful, limiting the length of the study to 1 year). Further research on this topic is encouraged.

Effects of age on outcomes in men receiving treatment for metastatic castration-resistant prostate cancer (mCRPC): Analysis of Medicare fee for service (FFS) claims data.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17590-e17590
Author(s):  
Tanya B. Dorff ◽  
Rana R. McKay ◽  
Carl A. Olsson ◽  
Kate Fitch ◽  
Scott Flanders ◽  
...  
Keyword(s):  
Claims Data ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Fee For Service ◽  
Coding System ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Common Procedure ◽  
Risk Of Death ◽  
Oral Agents

e17590 Background: Because elderly patients may exhibit differences in immune activation, we evaluated outcomes in men receiving first line treatment for mCRPC with sip-T or oral agents (ie, abiraterone acetate or enzalutamide) by age. Methods: Claims data from the 2013-2017 Centers for Medicare and Medicaid Services Fee for Service 100% Medicare Identifiable Database for Parts A, B and D were examined. We evaluated with index dates in 2014 and 3 years of follow-up. Patients were categorized by age (Table) and agent use as per Healthcare Common Procedure Coding System codes and National Drug Codes. First line use of sip-T vs oral agents was examined as was any line use of sip-T vs oral agents (without sip-T). Kaplan-Meier methodology was used to assess survival with Cox proportional hazards regression modelling used to calculate hazard ratios (HR). Results: Mean ages of men receiving sip-T and orals were 76 and 78 years, respectively. Most (84%) were white. Regardless of line of use, the risk of death among men receiving sip-T was lower than the risk in men receiving orals, except in men over 90 years old (Table). Conclusions: Based on these claims data, benefits of sip-T use were evident across all ages except for the men 90+ years old with decreasing differences between agents with increasing age, as would be expected. While the oral agents may be perceived as more convenient, greater survival with sip-T suggests that clinicians should consider use of sip-T therapy for mCRPC, irrespective of age. [Table: see text]

Biosimilar usage in practices within the ASCO PracticeNET learning network.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 77-77
Author(s):  
Brian Bourbeau ◽  
Elizabeth Garrett-Mayer ◽  
Mou Guharoy ◽  
Richard L. Schilsky
Keyword(s):  
Steady Increase ◽  
Coding System ◽  
Biosimilar Product ◽  
Billing Data ◽  
Common Procedure ◽  
Learning Network ◽  
Data Practices ◽  
Wide Range ◽  
The Cost ◽  
Potential Opportunity

77 Background: In recent years, several antineoplastic biosimilar products have been approved and marketed for use. We analyzed data from the ASCO PracticeNET learning network to gain insights on the adoption of biosimilar products for bevacizumab, rituximab, and trastuzumab. Methods: Our analysis included the following products: bevacizumab, bevacizumab-awwb, bevacizumab-bvzr, rituximab (excluding rituximab and hyaluronidase), rituximab-abbs, trastuzumab, trastuzumab-anns, and trastuzumab-dkst, administered from July 2019 to March 2020. 19 practices submitted their billing data; practices ranged in size from 2 to 29 hematologists/oncologists. Products were identified through use of healthcare common procedure coding system codes. The proportion of biosimilar product doses administered, as a percent of total doses for all related products, was calculated per participating practice. Results: Use of biosimilar products for bevacizumab (first biosimilar approval in September 2017) was first detected in August 2019, averaging 1.4% of administered doses (confidence intervals included in Table) with a range from 0% to 27% among participating practices; by March 2020, average use increased to 31% with a range from 0% to 100%. Use of biosimilar products for rituximab (first biosimilar approval in November 2018), was first detected in January 2020, averaging 2.6% of administered doses, with range of 0% to 30%; by March 2020, average use increased to 18%, with a range of 0% to 61%. Use of biosimilar products for trastuzumab (first biosimilar approval in December 2017) was first detected in September 2019, averaging 0.9% of administered doses with a range of 0% to 17%; by March 2020, average use increased to 35%, with a range of 0% to 98%. Conclusions: The release of biosimilar products has been identified as a potential opportunity to lower the cost of drug therapy for cancer patients. Our analysis identified an approximate 2-year lag from product approval to initial utilization followed by a steady increase in the use of biosimilar products, along with a wide range of use among practices. [Table: see text]

scholarly journals Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States

2020 ◽  
Vol 33 (11) ◽  
pp. 999-1002
Author(s):  
Raj Desai ◽  
Eric A Dietrich ◽  
Haesuk Park ◽  
Steven M Smith
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
The United States ◽  
Coding System ◽  
Pressure Monitoring ◽  
Common Procedure ◽  
Out Of Pocket Payments

Abstract Background Clinical guidelines increasingly recommended ambulatory blood pressure monitoring (ABPM) for hypertension diagnosis and management. Yet, ABPM is used infrequently in the United States, possibly because of low insurance coverage and high patient costs. We sought to analyze out-of-pocket payments (OPPs) for ABPM among privately insured patients. Methods We conducted a retrospective analysis using IBM® MarketScan® commercial claims of beneficiaries aged ≥18 years receiving ABPM from January 2012 to December 2018. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered the index date. Patients with 12 months of continuous enrollment preindex and 30-day postindex were included. Per beneficiary OPP was calculated by aggregating all ABPM-related OPPs within the 30-day postindex window (ABPM episode). Results Of 22,317 beneficiaries receiving ABPM, 62% had $0 OPP and 38% had OPP &gt;$0. Among the latter, median OPP per beneficiary for an ABPM episode was $23 (interquartile range [IQR], $14, $32), driven primarily by full ABPM claims (median, $22; IQR, $14, $24). Among individual components, scan analysis and report claims (median, $25; IQR, $13, $49) had the greatest OPP. The median OPP per ABPM episode did not change substantively from 2012 through 2018. Conclusions Among commercially insured in the United States, nearly 4-in-10 have an OPP for ABPM. Though most OPPs are relatively modest, some patients incur substantial OPP. Our findings highlight the need for policymakers to ensure adequate ABPM coverage in the commercial insurance marketplace.

scholarly journals Pulmonary arterial hypertension associated with interferon therapy: a population-based study

2017 ◽  
Vol 12 ◽  
Author(s):  
Ravikanth Papani ◽  
Alexander G. Duarte ◽  
Yu-li Lin ◽  
Yong-Fang Kuo ◽  
Gulshan Sharma
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Interferon Therapy ◽  
Rare Event ◽  
Population Based ◽  
Interferon Α ◽  
Coding System ◽  
Common Procedure ◽  
Pulmonary Arterial

Background: Isolated cases of pulmonary arterial hypertension (PAH) with interferon α or β therapy have been reported, but no population-based estimates of the incidence of the disease after interferon exposure are available. The aim of this study was to determine the incidence of PAH after initiation of interferon therapy, using a large commercial insurance database. Methods: Using National Drug Codes (NDCs) and Healthcare Common Procedure Coding System (HCPCS) codes, we utilized the Clinformatics™ Data Mart (CDM) database to identify subjects between 20 and 65 years old who received α or β interferon therapy between April 2001 and December 2012. Patients were followed from one year prior to the first medication claim for interferon to the first diagnosis of pulmonary hypertension using ICD-9-CM codes 416.0 and 416.8, or disenrollment. In those subjects diagnosed with pulmonary hypertension, a prescription for PAH-specific medications was used as a surrogate endpoint. Results: We identified 20,113 subjects who received interferon therapy during the study period. The median follow-up was 20 months. Pulmonary hypertension occurred in 71 subjects, and PAH-specific medications were prescribed to 7 of these subjects. Conclusion: Although our analysis showed that the development of PAH is a rare event with

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