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Sensitivity & positive predictive value of Medicare Part B physician claims for rheumatologic diagnoses & procedures

  [ 34 votes ]   [ Discuss This Article ]
By Katz JN, Barrett J, Liang MH, Bacon AM, Kaplan H, Kieval RI, Lindsey SM, Robert s WN, Sheff DM, Spencer RT, Weaver AL, Baron JA • www.ProHealth.com • September 5, 1997


OBJECTIVE: To examine the sensitivity and positive predictive
value of Medicare physician claims for select rheumatic
conditions managed in rheumatology specialty practices.

METHODS: Eight rheumatologists in 3 states abstracted 378
patient office records to obtain information on diagnosis and
office procedures. The Medicare Part B physician claims for
these patient visits were obtained from the Health Care
Financing Administration. The sensitivity of the claims data
for a specific diagnosis was calculated as the proportion of
all patients whose office records for a particular visit
documented that diagnosis and who also had physician claims
for that visit which identified that diagnosis. The positive
predictive value was evaluated in a separate sample of 331
patient visits identified in Medicare physician claims. The
positive predictive value of the claims data for a specific
diagnosis was calculated as the proportion of patients with
that diagnosis coded in the claims for a particular visit who
also had the diagnosis documented in the medical record for
that visit.

RESULTS: Ninety percent of abstracted office
medical records were matched successfully with Medicare
physician claims. The sensitivity of the Medicare physician
claims was 0.90 (95% confidence interval [CI] 0.85-0.95) for
rheumatoid arthritis (RA), 0.85 (95% CI 0.73-0.97) for
systemic lupus erythematosus (SLE), and 0.85 (95% CI 0.78-1.0)
for aspiration or injection procedures. The sensitivity for
osteoarthritis (OA) of the hip or knee was < or = 0.50 if
5-digit codes specifying anatomic site were required. The
sensitivity for fibromyalgia (FM) was 0.48 (95% CI 0.28-0.68).
The positive predictive values were at least 0.90 for RA, SLE,
and aspiration or injection procedures. Positive predictive
values for FM and the 5-digit site-specific codes for OA of
the knee were 0.83 (95% CI 0.66-1.0) and 0.88 (95% CI
0.75-1.0), respectively, while the positive predictive value
of the 5-digit site-specific codes for OA of the hip was zero
(95% CI 0-0.26). The positive predictive value of OA at any
site was 0.83 (95% CI 0.76-0.90).

CONCLUSION: In specialty
practice, Medicare physician claims had high sensitivity and
positive predictive value for RA, SLE, OA without
specification of anatomic site, and injection or aspiration
procedures. The claims had lower sensitivity and predictive
value for FM and for OA of the hip. The accuracy of Medicare
physician claims for other conditions and in the primary care
setting requires further investigation.




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