Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries

Abstract Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of clinical densitometry 2008-10, Vol.11 (4), p.568-574
Hauptverfasser: Curtis, Jeffrey R, Laster, Andrew J, Becker, David J, Carbone, Laura, Gary, Lisa C, Kilgore, Meredith L, Matthews, Robert, Morrisey, Michael A, Saag, Kenneth G, Tanner, S. Bobo, MD, Delzell, Elizabeth
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 574
container_issue 4
container_start_page 568
container_title Journal of clinical densitometry
container_volume 11
creator Curtis, Jeffrey R
Laster, Andrew J
Becker, David J
Carbone, Laura
Gary, Lisa C
Kilgore, Meredith L
Matthews, Robert
Morrisey, Michael A
Saag, Kenneth G
Tanner, S. Bobo, MD
Delzell, Elizabeth
description Abstract Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5% national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3% for women and 9.1% for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19% and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at
doi_str_mv 10.1016/j.jocd.2008.07.004
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3429135</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1094695008002126</els_id><sourcerecordid>69793424</sourcerecordid><originalsourceid>FETCH-LOGICAL-c539t-2c4c637cc748632d91b899f6553e1232c1e9f09b0173cc933e8904d18e1f3c733</originalsourceid><addsrcrecordid>eNqFUk1v1DAQjRCIloU_wAH5xC1hbCdxLKFKbfmUWiH1g6uVdSZbL4ld7KTS_nsm2hVfB7iMR_ab8XvzJstecig48PrNttgG2xUCoClAFQDlo-yYV5XOQZXqMeWgy7zWFRxlz1LaAgjOG_U0O6LYaFXCcRavcOOCbwf2tY2unShnzrPpDtk79I7uQ8-u0I3rOSYc0U-sD5GdBY_s0nmMhCBgctOO3WCanN-w0zFQvL1ml9g520ZkZ-ixd9bRF5ieZ0_6dkj44nCustsP72_OP-UXXz5-Pj-9yG0l9ZQLW9paKmtV2dRSdJqvG637uqokciGF5ah70GvgSlqrpcRGQ9nxBnkvrZJylZ3s-97P6xE7S9yJrbmPbmzjzoTWmT9fvLszm_BgZCk0lxU1eH1oEMP3mcSZ0SWLw9B6DHMytVaasOV_gZzY1YJUrDKxB9oYUorY_2TDwSyemq1ZPDWLpwaUIU-p6NXvOn6VHEwkwNs9AGmaDw6jSdahtzT9iHYyXXD_7n_yV7kdnCfjhm-4w7QNc6T9IBUmCQPmetmqZamgWRZK1PIH8XTIcg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>19336286</pqid></control><display><type>article</type><title>Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Curtis, Jeffrey R ; Laster, Andrew J ; Becker, David J ; Carbone, Laura ; Gary, Lisa C ; Kilgore, Meredith L ; Matthews, Robert ; Morrisey, Michael A ; Saag, Kenneth G ; Tanner, S. Bobo, MD ; Delzell, Elizabeth</creator><creatorcontrib>Curtis, Jeffrey R ; Laster, Andrew J ; Becker, David J ; Carbone, Laura ; Gary, Lisa C ; Kilgore, Meredith L ; Matthews, Robert ; Morrisey, Michael A ; Saag, Kenneth G ; Tanner, S. Bobo, MD ; Delzell, Elizabeth</creatorcontrib><description>Abstract Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5% national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3% for women and 9.1% for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19% and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at &lt;23 mo, the proportion of claims denied ranged from 2% to 43%, depending on Medicare carrier. Denial of Medicare reimbursement for DXA varies significantly by sex, time since previous DXA, ICD-9 diagnosis code submitted, place of service (office vs facility), and local Medicare carrier. Greater guidance and transparency in coding policies are needed to ensure that DXA as a covered service is reimbursed for Medicare beneficiaries with the appropriate indications.</description><identifier>ISSN: 1094-6950</identifier><identifier>EISSN: 1559-0747</identifier><identifier>DOI: 10.1016/j.jocd.2008.07.004</identifier><identifier>PMID: 18789740</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Absorptiometry, Photon - economics ; Aged ; Aged, 80 and over ; Bone Density ; Bone mineral density ; dual-energy X-ray absorptiometry ; Endocrinology &amp; Metabolism ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Medicare - economics ; osteoporosis ; Reimbursement Mechanisms - economics ; United States</subject><ispartof>Journal of clinical densitometry, 2008-10, Vol.11 (4), p.568-574</ispartof><rights>The International Society for Clinical Densitometry</rights><rights>2008 The International Society for Clinical Densitometry</rights><rights>2008 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved. 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-2c4c637cc748632d91b899f6553e1232c1e9f09b0173cc933e8904d18e1f3c733</citedby><cites>FETCH-LOGICAL-c539t-2c4c637cc748632d91b899f6553e1232c1e9f09b0173cc933e8904d18e1f3c733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jocd.2008.07.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18789740$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Curtis, Jeffrey R</creatorcontrib><creatorcontrib>Laster, Andrew J</creatorcontrib><creatorcontrib>Becker, David J</creatorcontrib><creatorcontrib>Carbone, Laura</creatorcontrib><creatorcontrib>Gary, Lisa C</creatorcontrib><creatorcontrib>Kilgore, Meredith L</creatorcontrib><creatorcontrib>Matthews, Robert</creatorcontrib><creatorcontrib>Morrisey, Michael A</creatorcontrib><creatorcontrib>Saag, Kenneth G</creatorcontrib><creatorcontrib>Tanner, S. Bobo, MD</creatorcontrib><creatorcontrib>Delzell, Elizabeth</creatorcontrib><title>Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries</title><title>Journal of clinical densitometry</title><addtitle>J Clin Densitom</addtitle><description>Abstract Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5% national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3% for women and 9.1% for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19% and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at &lt;23 mo, the proportion of claims denied ranged from 2% to 43%, depending on Medicare carrier. Denial of Medicare reimbursement for DXA varies significantly by sex, time since previous DXA, ICD-9 diagnosis code submitted, place of service (office vs facility), and local Medicare carrier. Greater guidance and transparency in coding policies are needed to ensure that DXA as a covered service is reimbursed for Medicare beneficiaries with the appropriate indications.</description><subject>Absorptiometry, Photon - economics</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone Density</subject><subject>Bone mineral density</subject><subject>dual-energy X-ray absorptiometry</subject><subject>Endocrinology &amp; Metabolism</subject><subject>epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicare - economics</subject><subject>osteoporosis</subject><subject>Reimbursement Mechanisms - economics</subject><subject>United States</subject><issn>1094-6950</issn><issn>1559-0747</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQjRCIloU_wAH5xC1hbCdxLKFKbfmUWiH1g6uVdSZbL4ld7KTS_nsm2hVfB7iMR_ab8XvzJstecig48PrNttgG2xUCoClAFQDlo-yYV5XOQZXqMeWgy7zWFRxlz1LaAgjOG_U0O6LYaFXCcRavcOOCbwf2tY2unShnzrPpDtk79I7uQ8-u0I3rOSYc0U-sD5GdBY_s0nmMhCBgctOO3WCanN-w0zFQvL1ml9g520ZkZ-ixd9bRF5ieZ0_6dkj44nCustsP72_OP-UXXz5-Pj-9yG0l9ZQLW9paKmtV2dRSdJqvG637uqokciGF5ah70GvgSlqrpcRGQ9nxBnkvrZJylZ3s-97P6xE7S9yJrbmPbmzjzoTWmT9fvLszm_BgZCk0lxU1eH1oEMP3mcSZ0SWLw9B6DHMytVaasOV_gZzY1YJUrDKxB9oYUorY_2TDwSyemq1ZPDWLpwaUIU-p6NXvOn6VHEwkwNs9AGmaDw6jSdahtzT9iHYyXXD_7n_yV7kdnCfjhm-4w7QNc6T9IBUmCQPmetmqZamgWRZK1PIH8XTIcg</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Curtis, Jeffrey R</creator><creator>Laster, Andrew J</creator><creator>Becker, David J</creator><creator>Carbone, Laura</creator><creator>Gary, Lisa C</creator><creator>Kilgore, Meredith L</creator><creator>Matthews, Robert</creator><creator>Morrisey, Michael A</creator><creator>Saag, Kenneth G</creator><creator>Tanner, S. Bobo, MD</creator><creator>Delzell, Elizabeth</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20081001</creationdate><title>Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries</title><author>Curtis, Jeffrey R ; Laster, Andrew J ; Becker, David J ; Carbone, Laura ; Gary, Lisa C ; Kilgore, Meredith L ; Matthews, Robert ; Morrisey, Michael A ; Saag, Kenneth G ; Tanner, S. Bobo, MD ; Delzell, Elizabeth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-2c4c637cc748632d91b899f6553e1232c1e9f09b0173cc933e8904d18e1f3c733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Absorptiometry, Photon - economics</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone Density</topic><topic>Bone mineral density</topic><topic>dual-energy X-ray absorptiometry</topic><topic>Endocrinology &amp; Metabolism</topic><topic>epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicare - economics</topic><topic>osteoporosis</topic><topic>Reimbursement Mechanisms - economics</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Curtis, Jeffrey R</creatorcontrib><creatorcontrib>Laster, Andrew J</creatorcontrib><creatorcontrib>Becker, David J</creatorcontrib><creatorcontrib>Carbone, Laura</creatorcontrib><creatorcontrib>Gary, Lisa C</creatorcontrib><creatorcontrib>Kilgore, Meredith L</creatorcontrib><creatorcontrib>Matthews, Robert</creatorcontrib><creatorcontrib>Morrisey, Michael A</creatorcontrib><creatorcontrib>Saag, Kenneth G</creatorcontrib><creatorcontrib>Tanner, S. Bobo, MD</creatorcontrib><creatorcontrib>Delzell, Elizabeth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical densitometry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Curtis, Jeffrey R</au><au>Laster, Andrew J</au><au>Becker, David J</au><au>Carbone, Laura</au><au>Gary, Lisa C</au><au>Kilgore, Meredith L</au><au>Matthews, Robert</au><au>Morrisey, Michael A</au><au>Saag, Kenneth G</au><au>Tanner, S. Bobo, MD</au><au>Delzell, Elizabeth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries</atitle><jtitle>Journal of clinical densitometry</jtitle><addtitle>J Clin Densitom</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>11</volume><issue>4</issue><spage>568</spage><epage>574</epage><pages>568-574</pages><issn>1094-6950</issn><eissn>1559-0747</eissn><abstract>Abstract Although the Bone Mass Measurement Act outlines the indications for central dual-energy X-ray absorptiometry (DXA) testing for US Medicare beneficiaries, the specifics regarding the appropriate ICD-9 codes to use for covered indications have not been specified by Medicare and are sometimes ambiguous. We describe the extent to which DXA reimbursement was denied by gender and age of beneficiary, ICD-9 code submitted, time since previous DXA, whether the scan was performed in the physician's office and local Medicare carrier. Using Medicare administrative claims data from 1999 to 2005, we studied a 5% national sample of beneficiaries age ≥65 yr with part A + B coverage who were not health maintenance organization enrollees. We identified central DXA claims and evaluated the relationship between the factors listed above and reimbursement for central DXA (CPT code 76075). Multivariable logistic regression was used to evaluate the independent relationship between DXA reimbursement, ICD-9 diagnosis code, and Medicare carrier. For persons who had no DXA in 1999 or 2000 and who had 1 in 2001 or 2002, the proportion of DXA claims denied was 5.3% for women and 9.1% for men. For repeat DXAs performed within 23 mo, the proportion denied was approximately 19% and did not differ by sex. Reimbursement varied by more than 6-fold according to the ICD-9 diagnosis code submitted. For repeat DXAs performed at &lt;23 mo, the proportion of claims denied ranged from 2% to 43%, depending on Medicare carrier. Denial of Medicare reimbursement for DXA varies significantly by sex, time since previous DXA, ICD-9 diagnosis code submitted, place of service (office vs facility), and local Medicare carrier. Greater guidance and transparency in coding policies are needed to ensure that DXA as a covered service is reimbursed for Medicare beneficiaries with the appropriate indications.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>18789740</pmid><doi>10.1016/j.jocd.2008.07.004</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1094-6950
ispartof Journal of clinical densitometry, 2008-10, Vol.11 (4), p.568-574
issn 1094-6950
1559-0747
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3429135
source MEDLINE; Access via ScienceDirect (Elsevier)
subjects Absorptiometry, Photon - economics
Aged
Aged, 80 and over
Bone Density
Bone mineral density
dual-energy X-ray absorptiometry
Endocrinology & Metabolism
epidemiology
Female
Humans
Logistic Models
Male
Medicare - economics
osteoporosis
Reimbursement Mechanisms - economics
United States
title Regional Variation in the Denial of Reimbursement for Bone Mineral Density Testing Among US Medicare Beneficiaries
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T11%3A18%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Regional%20Variation%20in%20the%20Denial%20of%20Reimbursement%20for%20Bone%20Mineral%20Density%20Testing%20Among%20US%20Medicare%20Beneficiaries&rft.jtitle=Journal%20of%20clinical%20densitometry&rft.au=Curtis,%20Jeffrey%20R&rft.date=2008-10-01&rft.volume=11&rft.issue=4&rft.spage=568&rft.epage=574&rft.pages=568-574&rft.issn=1094-6950&rft.eissn=1559-0747&rft_id=info:doi/10.1016/j.jocd.2008.07.004&rft_dat=%3Cproquest_pubme%3E69793424%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=19336286&rft_id=info:pmid/18789740&rft_els_id=1_s2_0_S1094695008002126&rfr_iscdi=true