Mackenzie Samuel J, Lin Chun Chieh, Todd Peter K, Burke James F, Callaghan Brian C
Division of Pediatric Neurology (S.J.M.), Department of Pediatrics, University of Michigan; Department of Neurology (C.C.L, P.K.T., J.F.B, B.C.C.), University of Michigan; Department of Veterans Affairs Ann Arbor Healthcare System (P.K.T., J.F.B, B.C.C.); and the Institute for Healthcare Policy and Innovation (J.F.B, B.C.C.), University of Michigan, Ann Arbor, MI.
Neurol Genet. 2020 Feb 26;6(2):e405. doi: 10.1212/NXG.0000000000000405. eCollection 2020 Apr.
To determine the utilization of genetic testing in patients seen by a neurologist within a large private insurance population.
Using the Optum health care claims database, we identified a cross-sectional cohort of patients who had been evaluated by a neurologist no more than 30 days before initial genetic testing. Within this group, we then categorized genetic testing between 2014 and 2016 on the basis of the Current Procedural Terminology (CPT) codes related to molecular and genetic testing. We also evaluated the International Classification of Disease Version 9 Clinical Code Classifications (ICD-9 CCS) associated with testing.
From 2014 to 2016, a total of 45,014 claims were placed for 29,951 patients who had been evaluated by a neurologist within the preceding 30 days. Of these, 29,926 (66.5%) were associated with codes that were too nonspecific to infer what test was actually performed. Among those claims where the test was clearly identifiable, 7,307 (16.2%) were likely obtained for purposes of neurologic diagnosis, whereas the remainder (17.2%) was obtained for non-neurological purposes. An additional 3,793 claims (8.4%) wherein the test ordered could not be clearly identified were associated with a neurology-related ICD-9 CCS.
Accurate assessment of genetic testing utilization using claims data is not possible given the high prevalence of nonspecific codes. Reducing the ambiguity surrounding the CPT codes and the actual testing performed will become even more important as more genetic tests become available.
确定在一大群购买私人保险的人群中，神经科医生所诊治患者的基因检测使用情况。
利用Optum医疗保健理赔数据库，我们确定了一个横断面队列，这些患者在首次进行基因检测前不超过30天曾由神经科医生进行评估。在这个群体中，我们随后根据与分子和基因检测相关的现行程序术语（CPT）代码，对2014年至2016年期间的基因检测进行了分类。我们还评估了与检测相关的国际疾病分类第9版临床代码分类（ICD-9 CCS）。
2014年至2016年期间，共有45,014份理赔申请涉及29,951名在过去30天内由神经科医生评估过的患者。其中，29,926份（66.5%）与过于不具体的代码相关，无法推断实际进行了何种检测。在那些检测可明确识别的理赔申请中，7,307份（16.2%）可能是为了神经科诊断目的而进行的，而其余的（17.2%）是为了非神经科目的进行的。另外3,793份（8.4%）理赔申请中，所订购的检测无法明确识别，但与神经科相关的ICD-9 CCS相关。
鉴于非特异性代码的高发生率，利用理赔数据准确评估基因检测的使用情况是不可能的。随着更多基因检测的出现，减少CPT代码及实际进行的检测周围的模糊性将变得更加重要。
