Friday, July 14, 2006

Complication Rates Complicated

I hate the "complication numbers game." Public health enthusiasts who peruse Medicare databases need to understand the limitations of their research.

Recently, an article was published in the Journal of the American College of Cardiology (the abstract here) that was picked up by the press with headlines that 1 in 10 defibrillator implants resulted in a complication. To the casual reader, this seems like an incredibly high rate.

But careful reading of their research demonstrated that this was determined in some circumstances by analysis of a Medicare ICD9 code, 996.04, that means "Mechanical Complication of an Implantable Cardiac Defibrillator (ICD)." But realize there is no code for "dead or dying battery" in the less-than-robust Medicare coding scheme, and doctors will not get paid unless the proper code accompanies the procedure code (called a CPT code). When batteries die, the closest code we have to assure reimbursement that does not result in Medicare billing fraud, is ICD9 996.04, and yet is NOT a complication, but proper care.

The media and journals continue to get caught up in "trends" - the latest of which seems to be the horrible health care delivered in America. While there certainly is room for improvement, this complication rate study is yet another example of caveat emptor.

So rest assured, this estimate is high, REALLY high, and it can be explained by the imperfections of the Medicare coding scheme with which we doctors have to live.


1 comment:

Anonymous said...

Hey Wes, Excellent analysis about the ICD "complication" rates. Makes me wonder about any analysis done w/ Medicare ICD9 codes since we often put in codes which are close enough for reimbursement.

I think more lay people ought to see this analysis so that they are aware that there are "lies, damned lies, and statistics".

Matt Fischer