Terminology Codes Research Articles

Analysis of a National Database Investigating Development of Trigger Finger after Treatment of Dupuytren Disease.

A commercial database encompassing 53 million patients was utilized from January 1, 2010 to March 31, 2020. The study cohort included patients diagnosed with either Dupuytren disease or trigger finger utilizing International Classification Codes 9 and 10. Terminology codes were used to identify common Dupuytren procedures, as well as trigger finger release. Logistic regression analysis was used to define independent risk factors for developing trigger finger. A total of 593,606 patients were diagnosed with trigger finger. Of these patients, 15,416 (2.6%) were diagnosed with trigger finger after diagnosis of Dupuytren disease, whereas 2603 (0.4%) patients were diagnosed with trigger finger after treatment of Dupuytren contracture. Independent risk factors for trigger finger included age 65 years or older (OR 1.00, P < 0.05), diabetes (OR 1.12, P < 0.05) and obesity (OR 1.20, P < 0.005). Patients who received collagenase clostridium histolyticum treatment (OR 0.34, P < 0.005) for Dupuytren contracture were significantly less likely to develop trigger finger. Dupuytren contracture is associated with inflammation and subsequent trigger finger development at a higher rate than the background population frequency. Collagenase clostridium histolyticum injection may lead to a decreased risk of trigger finger requiring surgical intervention in patients with risk factors.

The novel and powerful ICD-11 classification system for neoplasm coding: a comparative study with the ICD-O

BackgroundThe International Classification of Diseases (ICD) and the International Classification of Diseases for Oncology (ICD-O) are both widely used global classification systems. In 2018, the initial release of the ICD-11 was published by the World Health Organization (WHO), integrating the morphology section of the ICD-O.MethodsThis paper aims to provide potential ICD-11 users with a profound understanding of the neoplasm classifications of the ICD-11 by analysing the differences and relationships between the ICD-11 and ICD-O in terms of the coding framework, compatibility and intelligence level.ResultsThe ICD-11 and ICD-O have remarkable differences in coding structure. Compared to the ICD-O, the ICD-11 has the following advantages: adding histopathology to the stem codes, obtaining a meaningful minimum amount of information through stem codes for statistics, supporting the usage of ICD-O morphology categories and capturing clinical details via extension codes for multiaxial coding. In addition, the rich Foundation Component, linearization derived from the Foundation Component and updating mechanism all support the compatibility of the ICD-11 with other classification systems. Notably, the WHO provides terminology coding with a smart coding tool, and coding in the ICD-11 can draw on statistical codes and uniform resource identifiers (URIs) simultaneously.ConclusionsThe ICD-11 represents a novel classification system with distinguishing features that include facilitating statistics, multiaxial coding, coding granularity, compatibility and intelligence. These features enable the ICD-11 to be more powerful for neoplasm coding than the ICD-O and basically meet the needs of stakeholders.

Patients undergoing colorectal surgery at a Veterans Affairs Hospital do not experience racial disparity in length of stay either before or after implementing an enhanced recovery pathway

BackgroundEnhanced Recovery Pathways (ERP) have been shown to reduce racial disparities following surgery. The objective of this study is to determine whether ERP implementation mitigates racial disparities at a Veterans Affairs Hospital.MethodsA retrospective cohort study was conducted using data obtained from the Veterans Affairs Surgical Quality Improvement Program. All patients undergoing elective colorectal surgery following ERP implementation were included. Current procedural terminology (CPT) codes were used to identify patients who underwent similar procedures prior to ERP implementation.ResultsOur study included 417 patients (314 pre-ERP vs. 103 ERP), 97.1% of which were male, with an average age of 62.32 (interquartile range (IQR): 25–90). ERP patients overall had a significantly shorter post-operative length of stay (pLOS) vs. pre-ERP patients (median 4 days (IQR: 3–6.5) vs. 6 days (IQR: 4–9) days (p < 0.001)). Within the pre-ERP group, median pLOS for both races was 6 days (IQR: 4–6; p < 0.976) and both groups experienced a decrease in median pLOS (4 vs. 6 days; p < 0.009 and p < 0.001) following ERP implementation.ConclusionsRacial disparities did not exist in patients undergoing elective surgery at a single VA Medical Center. Implementation of an ERP significantly reduced pLOS for black and white patients.

Abstract P3-04-02: Real world evidence demonstrates replacement of 2D mammography with 3D mammography among insured women

Abstract Background Digital breast tomosynthesis (DBT), also called 3D mammography, was first approved by the Federal Drug Administration in 2011. The goal of 3D mammography is to improve accuracy compared to 2D digital mammography (DM), by increasing sensitivity and decreasing recall rates. To capture the broad utilization of DBT in populations receiving both screening and diagnostic imaging, this analysis investigates DBT usage over time in a longitudinal sample from 2016 through 2020 for adult women ranging from 18-74 years of age. Methods Retrospective analyses were conducted using de-identified administrative claims data from a large national U.S. health insurer. The study cohort consisted of women who were continuously enrolled in a commercial or Medicare Advantage plan from 1/2016 to 12/2020 and aged 18 to 74 years old as of 2016. All procedures were identified based on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. For each study year, receipt of breast cancer screening with DM (S-DM) or including DBT (S-DBT) were captured. Receipt of DM and DBT not specified for screening based on CPT code descriptions were categorized as diagnostic, D-DM and D-DBT respectively. Women that received both DBT and DM in the same year were included in the DBT group. In addition, women who received MRI and ultrasound were also captured. Rates of each procedure by study year, insurance type, and age categories that align with recommended screening guidelines (&amp;lt;40 years old, 40-49 years old and 50-74 years old) were examined. Results Approximately 3.8 million women met study criteria; 85% were commercially insured and 15% were Medicare Advantage. Table 1 shows rates of adult women who received mammography, MRI and ultrasound over the study period. About 74% of study subjects receiving screening were 50-74 years old at the start of the study period, 25% were 40-49 years and 1% were under 40 years old. In 2020, there were fewer women (3%-13%) receiving imaging procedures compared to counts in 2019. During the 5-year study period, there was a 3.5-fold increase in the number of women who received S-DBT. In 2016, 23% of women who received a screening mammogram received S-DBT and by 2020, this percent increased to 82%. The percent of women who received a diagnostic mammogram using D-DBT compared to D-DM also increased overtime; 29% of women received a D-DBT in 2016 and this increased to 77% in 2020. The number of women with receipt of ultrasound and MRI were similar in each study year. The percent diagnostic/screening tests (including DBT and DM) were in the range of 18.5%-20.2% each year. Conclusion Among this cohort of women who were continuously enrolled in the health plan throughout the 5-year study period, this analysis shows that screening and diagnostic DBT utilization rates increased from 2016 to 2020 while DM screening and diagnostic imaging utilization concomitantly decreased. The percentages of women that received S-DBT and D-DBT were highest in 2020, even though 8%-13% fewer women had evidence of mammography than in 2019, which is largely due to COVID-19 related healthcare service disruptions. The rate of diagnostic tests as a percent of screening tests did not decrease with the adoption of DBT. Further analyses investigating rates of follow-up procedures and downstream costs are warranted. Table. Rates of adult women who received digital breast tomosynthesis, digital mammography, MRI and ultrasound by age group and year from 2016-2020.Calendar YearAge Group categoryTotal women with ≥1 Screening Mammography, N% with S-DBT% with S-DMTotal women with ≥1 Diagnostic Mammography Procedure, N% with D-DBT% with D-DMWomen with at least ≥1 MRI procedureWomen with ≥1 Ultrasound procedure2016Total100175523%77%20237129%71%20786227790&amp;lt;401269724%76%1360831%69%16582428240-4925258521%79%5682729%71%55106767550-7473647323%77%13193629%71%136181358332017Total106871644%56%20791143%57%23153243413&amp;lt;401211451%49%1364146%54%17652405940-4925583346%54%5589544%56%60366963550-7480076944%56%13837543%57%153521497192018Total108956461%39%20584657%43%24901251678&amp;lt;401111869%31%1265262%38%18512256440-4925074764%36%5429058%42%64877061450-7482769960%40%13890456%44%165631585002019Total112823673%27%20895169%31%28394264503&amp;lt;401039081%19%1258674%26%19392202440-4925084376%24%5364069%31%71877230650-7486700372%28%14272568%32%192681701732020Total98572982%18%19229677%23%27580245350&amp;lt;40827988%12%1096381%19%18281850440-4920904185%15%4725377%23%67776438850-7476840982%18%13408076%24%18975162458 Citation Format: Stacey DaCosta Byfield, Kenneth Wimmer, Beatrice Amara Adajar, Peter Onglao, Annika Fredrickson, Maria Eloisa Ventura, James Staib, Kierstin Catlett, Rashna Soonavala, Mi-Ok Kim, Allison Fiscalini, Laura Esserman. Real world evidence demonstrates replacement of 2D mammography with 3D mammography among insured women [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-04-02.

Evaluation and Management: General Guidelines Applicable to Most Services

In this article, we review the following general instructions for Current Procedural Terminology (CPT®) code selection and guidelines and definitions that apply to most categories of E/M service.

Abstract TMP29: Emergency Department Variability In Use Of Advanced Neuroimaging By Insurance Status

Introduction: Prior data indicate inpatient disparities exist among patients with stroke associated with insurance status for degree of neurologic impairment, hospital length of stay and mortality. Patients presenting to the Emergency Department (ED) with acute neurologic symptoms often require evaluation for acute ischemic stroke and, in 2015, guidelines recommended CTA when LVO is considered. CTP was added in 2018 for select patients. In the ED, the Emergency Medical Treatment and Labor Act (EMTALA) requires anyone presenting to be stabilized and treated, regardless of insurance status and should limit variability in advanced neuroimaging use based on insurance status. We examined ED stroke assessment disparities by evaluating national variability in the use of advanced stroke imaging by primary payer (Private Insurance, Medicare, Medicaid, Self-Pay). Methods: Retrospective cohort study using adult encounters admitted to the same hospital in the 2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters. CTA (head/neck) and CTP imaging use was determined from Common Procedural Terminology (CPT) codes and adjusted by age. Rate per 100,000 ED visits were compared across primary payers using ANOVA with Tukey adjustment. Results: Age-adjusted CTP rates varied by payer but did not research statistical significance. Rates of CTA acquisition were significantly different across payer groups (p&lt;0.001). See Table. Conclusion: Variability in age-adjusted rates of advanced neuroimaging use in the ED was identified. The variability for CTP, a unique ED imaging modality for stroke, was not significant, however interpretation is limited by confidence interval size. Variability in CTA was significant between groups and will undergo further analysis to evaluate for confounding by other patient or hospital factors.

Abstract TMP37: Regional Changes And Variation In Emergency Department Use Of Neuroimaging During The Mechanical Thrombectomy Era

Introduction: Intracranial vascular imaging was rapidly incorporated into acute ischemic stroke guidelines after positive endovascular trials in 2015. Since then, indications for advanced neuroimaging have broadened as the time window for treatment of large vessel occlusion stroke expanded. Although neuroimaging has been added to national guidelines, there may be considerable lag in incorporating these practices into standard ED care based on regional practice. We sought to analyze regional changes and variation in advanced neuroimaging relevant to stroke. Methods: Longitudinal cohort study using adult encounters admitted to the same hospital in the National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters. Adult encounters from 2013 to 2018 were included in the analysis. CTA and CTP imaging acquired in the ED was determined from Common Procedural Terminology (CPT) codes. Imaging rates per 100k encounters were analyzed by predefined NEDS region (Northeast, Midwest, South, or West) and by year (2013 vs 2018). Descriptive statistics with t-test used for comparison. Results: All regions showed a significant increase in rate of CTA use over time (p&lt;0.001) with the Midwest demonstrating the largest percentage change (542%). All regions showed substantial increases in rate of CTP use across the time period with the Northeast having the largest magnitude of increase (5,376%) followed by the Midwest (1,035%). See Table for detail. Conclusion: Dramatic increases in CTA and CTP use by region were identified both in absolute terms and relative to their use in 2013. The findings demonstrate approximate geographic parity in order of magnitude of use with the change in usage suggesting rapid dissemination of new technologies in stroke imaging and future potential increases. Further analysis will evaluate other hospital properties to better understand changes in imaging rates nationally.

Home Health Care Utilization in Children With Medicaid.

Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions. Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

Care Management Services by Specialists and by Primary Care

New Current Procedural Terminology (CPT®) codes (99424–99427) for principal care management (PCM) can be beneficial to physicians and other qualified health care professionals (QHPs) in primary care and other pediatric specialties.

07. Recombinant Zoster Vaccine (RZV) Second-Dose Completion in Adults Age 50‒64 Years in the United States

BackgroundIn 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV, Shingrix) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥50 years, with the 2nd dose recommended 2–6 months after the 1st dose. Among Medicare beneficiaries, 2-dose series completion 6 months and 12 months post initiation was 78% and 86%, respectively. Here we estimate the proportion of adults age 50–64 years who completed the 2-dose RZV series within 6 or 12 months after receiving their 1st dose, by using two administrative claims databases. MethodsWe used medical and pharmaceutical claims data from October 2017‒March 2020 IQVIA® PharMetrics Plus and October 2017‒October 2020 IBM® MarketScan® databases. RZV vaccination was defined using Current Procedural Terminology and National Drug Codes. We allowed for sufficient follow-up time by examining 1st doses given at least 6 or 12 months prior to the end of the study period in both databases. Place of administration was available in IQVIA data.ResultsAmong persons age 50‒64 years, in IQVIA and MarketScan, 70% and 68% received their 2nd RZV dose within 6 months, respectively, and 79% and 81% received their 2nd dose within 12 months, respectively. The median age of 1st dose of RZV vaccination was 60 years and ~60% were female [Table 1]. When the 2nd dose was administered within 12 months, the median interval between 1st and 2nd doses was 104 and 98 days in the IQVIA and MarketScan databases, respectively. Characteristics by age, sex, or region were similar in persons who received 1 RZV dose vs. 2 RZV doses [Table 1]. Among those who received only 1 RZV dose with at least 12 months of follow-up time, 55% of vaccinations occurred at ambulatory medical provider offices and 40% at pharmacies; among 2 doses recipients, 33% of vaccinations occurred at provider offices and 62% at pharmacies. ConclusionAmong 50‒64-year-olds, 2-dose RZV series completion was ~70% within 6 months and 80% within 12 months of initiation. The findings were similar across two administrative claims databases. Availability of RZV at pharmacies has potentially helped to increase RZV 2nd dose completion rates. Disclosures All Authors: No reported disclosures

Abstract 10555: Genetic Testing Underutilization in Patients with Cardiomyopathy: A Real-World Data Analysis

Introduction: Professional guidelines support genetic testing (GT) for dilated, hypertrophic, restrictive, arrhythmogenic, and peripartum cardiomyopathy to confirm a diagnosis, guide management, enable clinical trials, and/or allow more informed genetic counseling. Analysis of de-identified data from a commercial laboratory showed that 1 in 4 individuals who had cardiomyopathy GT billed to a national health insurer had a positive result; however, which patients undergo GT is largely unknown. Hypothesis: GT is underutilized in patients with genetic cardiomyopathy. Methods: A retrospective analysis was conducted using commercial and Medicare claims data from the UnitedHealth Group Clinical Discovery Database. The GT-cohort (index: GT dates 1/1/2017-12/31/2020) included patients with 12-months pre-index data including ≥1 ICD-10 codes associated with genetic or unspecified cardiomyopathy and GT Current Procedural Terminology (CPT) code(s). The non-GT cohort (index: outpatient visit dates 1/1/2017-12/31/2020 with 12-month pre-index data) had the same ICD codes, but no GT CPT code. Individuals with a personal and/or family history of cancer were excluded to avoid patients who had GT for cancer. Multivariable logistic regression analysis was performed to examine factors associated with GT. Results: Of 300,127 patients with cardiomyopathy, 3,287 (1.1%) had a GT CPT code. Factors that predicted a higher likelihood of GT (p &lt; 0.05) included being younger, living in an area with a higher education level, commercial insurance, no diagnosis of diabetes or myocardial infarction, diagnosis of mild liver disease, a higher number of outpatient medical and cardiology visits, cardiac-related hospitalizations (shorter length-of-stay), a higher number of 30-day all-cause readmissions, a higher number of cardiomyopathy diagnoses, and except for peripartum, all genetic cardiomyopathy types. Conclusions: Only 1.1% of patients with a cardiomyopathy ICD code had a GT claim. Considering a potential 25% testing yield, a larger portion could have benefited from a genetics guided diagnosis. More research is needed to investigate barriers related to GT and improve our ability to identify those who could benefit from cardiomyopathy genetic testing.

Код у контексті лексикографічної фіксації термінів

. The article presents for the first time the norms according to which the formation of Ukrainian terminology took place, in particular the practical implementation of codification on Ukrainian basis. The purpose of the study is to analyze the origins of the concept of terminological code, which appeared at the beginning of the XXth century and was gradually established in connection with the lexicographic fixation of the terms, due to which the term elements gained the ability to spread and became easy to use. Materials and methods of research . The research was based on documents of the first third of the last century, which dealt with issues of standardization in terminology, as well as foreign and Ukrainian dictionaries. The descriptive method using the technique of external interpretation was used in this paper work, which demonstrates the general connections of realities, consciousness, thinking at the stage of formation of Ukrainian terminology. Discussion . It should be borne in on that the terminological code serves as a basis for the creation of modern terminological systems, caused by the cultural influence of classical languages f or many centuries. Conclusions . The terminology code helps to recognize foreign words not only among the languages of the Indo-European language family, but also other language families, expanding the process of interaction of terminological systems of closely related and remote related languages. The use of the terminological potential of classical languages by modern European languages is an important factor in the development of Greco-Latinisms.

Advance Care Planning for Patients with New Serious Illnesses after Medicare’s New Payments

Advance Care Planning (ACP) supports adults to understand and communicate their values and wishes for future medical care in order to ensure goal-concordant care in serious illness when patients are too ill to make their own decisions [1,2]. In recognition of the misalignment between payment for ACP and its value, the Center for Medicare &amp; Medicaid Services (CMS) authorized payment for ACP through new Current Procedural Terminology (CPT) codes (99497 and 99498) in 2016 [1].

CPT to RVU conversion improves model performance in the prediction of surgical case length

Methods used to predict surgical case time often rely upon the current procedural terminology (CPT) code as a nominal variable to train machine-learned models, however this limits the ability of the model to incorporate new procedures and adds complexity as the number of unique procedures increases. The relative value unit (RVU, a consensus-derived billing indicator) can serve as a proxy for procedure workload and could replace the CPT code as a primary feature for models that predict surgical case length. Using 11,696 surgical cases from Duke University Health System electronic health records data, we compared boosted decision tree models that predict individual case length, changing the method by which the model coded procedure type; CPT, RVU, and CPT–RVU combined. Performance of each model was assessed by inference time, MAE, and RMSE compared to the actual case length on a test set. Models were compared to each other and to the manual scheduler method that currently exists. RMSE for the RVU model (60.8 min) was similar to the CPT model (61.9 min), both of which were lower than scheduler (90.2 min). 65.2% of our RVU model’s predictions (compared to 43.2% from the current human scheduler method) fell within 20% of actual case time. Using RVUs reduced model prediction time by ninefold and reduced the number of training features from 485 to 44. Replacing pre-operative CPT codes with RVUs maintains model performance while decreasing overall model complexity in the prediction of surgical case length.

109 Outpatient Nursing Care Charges: A Process Improvement Project

Abstract Introduction High wound care complexity in a burn clinic mandates adequate nurse staffing and expertise to manage increasingly large wounds as outpatient. To achieve these service needs, appropriate charge capture is important for revenue generation. Our burn clinic performed a process improvement (PI) project using a Plan, Do, Study, Act (PDSA) cycle to improve the accuracy of charge capture for wound care episodes over the past 2 fiscal years (FY). Methods In the first phase (PLAN), we reviewed charges by 1-month sampling in FY20. We engaged stakeholders (medical and nursing providers, managers, revenue integrity and compliance teams) through iterative meetings. We performed a stakeholder analysis to identify their level of engagement, influence, and attitudes toward this PI. We next devised strategies for stakeholders to champion the project. The team developed and trialed the process by focusing on burn wound care Common Procedural Terminology (CPT) codes. In FY21, nurses began to enter CPT codes in accordance with burn wound care performed (DO). We then repeated a 1-month sampling of charges in FY21 (STUDY). We are now consolidating the new strategy, refreshing stakeholder engagement, and expanding it within our hospital (ACT). Results We identified multiple billing errors and opportunities to improve CPT code documentation for nursing wound care procedures in FY20. Stakeholder interviews revealed a gap between accurate billing and current practice. We proposed to alter the wound care billing workflow. Stakeholder engagement was high and well-represented among professional disciplines. In FY21 implementation, clinic nurses received the clinic coding in-service and were oriented to resource tools. We verified billing practice adherence via the institutional compliance department. FY21 sampling indicated a marked increase in accurate charges for burn wound care in the clinic (net+ $36,691). We have implemented real-time audits, identified and documented problems as they arise, and obtained feedback from nurses. The clinic is investigating non-burn wound care charge capture and has disseminated our findings through institutional shared governance. Conclusions The financial performance of outpatient burn nursing needs to be closely evaluated in today’s shifting healthcare environment. Using a PDSA process led by nurses, the accuracy of charge capture for complex wound care has substantially improved and led to increased revenue. This model is potentially translatable to other specialty clinics.

Abstract 14953: Temporal Trends in Non-invasive Diagnostic Tests for Ischemic Heart Disease Among Us Adults Age 64 Years or Younger: Results From the Marketscan Survey, 2010-2018

Introduction: Heart disease is the leading cause of death in the U.S. Ischemic heart disease (IHD) accounts for two thirds of heart disease deaths. Non-invasive cardiovascular tests (NITs) are often the first step to establish an IHD diagnosis. Methods: We analyzed 2010-2018 IBM® MarketScan® Commercial Databases. NITs including exercise ECG, stress echocardiography, CT coronary artery calcification score (CT-CAC), single-photon emission computerized tomography (SPECT), cardiac CT angiography (CTA), nuclear positron emission tomography/myocardial perfusion imaging (PET/MPI), stress MRI, were identified using current procedural terminology (CPT) codes. IHD using ICD 9/10 codes (410-414, 429.2/I20-I25) and chest pain (786.59/R07.89) or unspecified chest pain (786.50/R07.9) were identified. The 2000 Census population was used to calculate the age standardized prevalence. Results: The data included 20,726,587 individuals (48.1% men, mean age (standard deviation) of 49.1 (13.5) years), among which 67,339 had a diagnosis of IHD or chest pain in 2018. The age standardized prevalence of the overall population that had at least one of the 7 tests is 1.60% in 2018, down from 2.47% in 2010. The responding prevalence for those with IHD or chest pain was 54.3% in 2018 and 61.6% in 2010. Exercise ECG was the most utilized test for the overall population: 0.94% in 2018 down from 1.31% in 2010; SPECT was second most often used with 0.75% in 2018 and 1.24% in 2010. However, SPECT was the most often utilized test among those with CHD or chest pain: 38.2% in 2018, down from 45.0% in 2010, and exercise ECG second most often with 32.6% in 2018 and 34.9% in 2010. An increase in use of CT-CAC, PET/MPI, and CTA tests was observed since 2010, but the prevalence of all were low in 2018. 0.02%. 0.01%, and 0.04% for the overall population and 0.20%, 0.95% and 3.20% for those with IHD or chest pain, respectively. Conclusions: Almost 2% of the general younger US adult population and over half of those with IHD or chest pain had undergone at least one of 7 NITs in 2018. While the utilization of overall NITs for both the general population and those with IHD or chest pain has declined since 2010, it has increased for CT-CAC, PET/MPI, and CTA but still less than 1% for CT-CAC and PET/MPI..

Cervical spine degenerative disease is an independent risk factor for increased revision rate following total knee arthroplasty.

The relationship between cervical degenerative pathology and total knee arthroplasty (TKA) revision rates is not well understood. The aim of the study was to determine whether cervical spine degenerative diseases have a role in complications following TKA within 2years. Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007-2017. Patients who had a primary TKA were identified using Current Procedural Terminology (CPT) code 27,447, and patients with degenerative cervical disease were identified using CPT and International Classification of Diseases (ICD) codes. Data on patients' demographics, comorbidities and postoperative complications were recorded and analyzed with univariate and multivariate analysis with significance set at p < 0.05. A Kaplan-Meier analysis was conducted to estimate the 1- and 2-year rates of survival free from revision. A total of 81,873 patients were included in this study. Following multivariate analysis, cervical spine degenerative disease patients were at increased risk of all-cause revision surgery following 1year (OR: 1.342 95% CI: 1.149-1.569; p < 0.001) and 2year (OR: 1.338; 95% CI: 1.184-1.512; p < 0.001). At 2years, patients with cervical spine degenerative disease had a survival rate of 97.7%, while the survival rate was 99.2% among the non-cervical degenerative cohort. Based on these results, patients with cervical spine degenerative pathology should be counseled that their spinal pathology may impair outcomes following TKA.

2021 CPT® Updates: Codes of Interest to Pediatrics

This article reviews 2021 Current Procedural Terminology (CPT) code changes that will affect pediatricians. Changes for office and other outpatient evaluation and management service codes are reviewed separately in continuation of a series of articles that began in the January 2020 AAP Pediatric Coding Newsletter™.

Abstract PO-015: Differences in level-of-service for telehealth visits as compared to in-office visits for cancer and hematology patients seen in practices within the ASCO PracticeNET learning network

Abstract Introduction: In response to the need for social distancing and infection prevention during the COVID-19 pandemic, there has been increased use of telehealth services to manage cancer and hematology patients. Throughout March and April of 2020, the Medicare and Medicaid programs expanded coverage of telehealth services, allowing cancer and hematology patients to receive certain telehealth services from their home during the public health emergency. We analyzed data from ASCO’s PracticeNET learning network to examine the reported level-of-service for telehealth services compared to standard in-office visits. Methods: 20 practices submitted their billing data for analysis; practices were located in 14 states and ranged in size from 2 to 29 hematologists/oncologists. We analyzed a total of 33,435 established patient evaluation and management visits performed by hematologists/oncologists from March 15 to April 18, 2020. 3,062 (9.1%) visits were performed via telehealth and 30,373 were performed in a physician office or outpatient hospital department. The level-of-service of each visit was identified through the reported Current Procedure Terminology (CPT) code, where levels 1-5 correspond to CPT codes 99211-99215, respectively, and level 5 represents the highest complexity visit. Telehealth visits were identified through use of the modifiers 95, GQ, and GT, as appended to the applicable CPT code. Results: The level-of-service distribution for telehealth-based visits was level 1 (1%), level 2 (4%), level 3 (35%), level 4 (50%), and level 5 (11%). This contrasted with in-office visits: level 1 (3%), level 2 (2%), level 3 (27%), level 4 (51%), and level 5 (18%). Differences were greatest in level 3 visits (35% vs. 27%) and level 5 visits (11% vs. 18%). Differences in level-of-service persisted when exploring various disease cohorts, including patients with solid neoplasms, blood neoplasms, benign hematology disorders, and circulatory disorders. Conclusions: Analysis of established patient visits showed that telehealth visits were reported at lower level-of-service as compared to in-office visits. This finding may be related to directing straightforward visits to be performed via telehealth or due to limitations in using telehealth by patients with complex medical problems. Citation Format: Brian Bourbeau, Mou Guharoy, Stephen Grubbs, Elizabeth Garrett-Mayer, Kevin Olson, Richard L. Schilsky. Differences in level-of-service for telehealth visits as compared to in-office visits for cancer and hematology patients seen in practices within the ASCO PracticeNET learning network [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-015.

Factors Contributing to Extended Hospital Length of Stay in Emergency General Surgery†

Background Emergency general surgery (EGS) is a field characterized by disproportionately high costs, post-operative mortality, and complications. We attempted to identify independent factors predictive of an increased postoperative length of stay (LOS), a key contributor to economic burden and worse outcomes. Methods The ACS-NSQIP database was queried for data from2005 to 2017. Current procedural terminology (CPT) codes were used to identify the most commonly performed EGS procedures: appendectomy, bowel resection, colectomy, and cholecystectomy. Cohorts above and below 75th percentile LOS were determined, compared by preoperative variables, and evaluated with univariate and multivariate logistic regression to quantify risk. Results Of 267,495 cases, 70,703 cases were above the 75th percentile for LOS. A larger proportion of patients in the extended LOS group were 41 years or older (88.6% vs 45.7%). More Blacks (10.3% vs 6.7%) were observed in the extended LOS group. Age, race, cardiopulmonary, hepatic, and renal disease, diabetes, recent weight loss, steroid use, and sepsis history were significant factors on multivariate analysis but varied in terms of risk proportion by procedure. Age (61+), Black race, hypertension, sepsis, and cancer were significant for all 4 procedures. Conclusions Several factors are independently associated with extended LOS for those undergoing the most common EGS procedures. Five of these were associated with an increased LOS for all four procedures. These included, age (61+), hypertension, sepsis, cancer, and Black race.