Repeated upper endoscopy in the Medicare population: a retrospective analysis.

BACKGROUND

Esophagogastroduodenoscopy (EGD) is done often for various indications. Little is known about the frequency of repeated EGD and the diagnoses that drive it.

OBJECTIVE

To describe the frequency of repeated EGD in the Medicare population and determine diagnoses most often associated with it.

DESIGN

Retrospective analysis.

SETTING

Medicare database.

PATIENTS

Among a 5% random sample of Medicare beneficiaries, Current Procedural Terminology (CPT) codes were used to identify patients who had an index EGD between 2004 and 2006. Diagnoses from the International Classification of Diseases, Ninth Revision, Clinical Modification, reported for the index endoscopy were divided into 3 diagnostic groups on the basis of whether the index diagnosis suggested that repeated EGD was expected, uncertain, or not expected.

MEASUREMENTS

Proportion of patients with repeated EGD within 3 years of an index EGD.

RESULTS

Approximately 12% of Medicare beneficiaries had an EGD between 2004 and 2006 (n = 108 785). Of these, 33% (n = 36 331) had at least 1 repeated EGD within 3 years. Of all patients with initial EGDs, 10% (n = 11 370) had an associated diagnosis suggesting a need for follow-up examination, whereas 61% (n = 66 307) did not. Of all patients with repeated examinations, 54% (n = 19 687) came from the group in which repeated EGD was not expected. When new clinical events were excluded, 43% of all patients with repeated EGDs (n = 15 706) did not have a diagnosis at index or repeated EGD that justified a repeated examination.

LIMITATION

Whether individual procedures were clinically indicated cannot be verified.

CONCLUSION

One in 3 Medicare beneficiaries who received an EGD had a repeated EGD within 3 years. Nearly one half of repeated examinations were done in patients with diagnoses at index or repeated EGD that did not suggest the need for a repeated examination.

PRIMARY FUNDING SOURCE

None.