BACKGROUND: To curb increasing volumes of diagnostic imaging and costs, reimbursement for @entity3538 ( @entity3538 ) is dependent on "appropriate" indications as documented by @entity66 ( @entity66 ) codes entered by ordering physicians. Historically, asymptomatic indications for @entity3538 yield lower rates of abnormal results than symptomatic indications, and consensus documents agree that most asymptomatic indications for @entity3538 are inappropriate. In our vascular laboratory, we perceived an increased rate of @entity66 . We therefore sought to determine if @entity66 codes were useful in predicting the frequency of abnormal @entity3538 . We hypothesized that asymptomatic or nonspecific @entity66 codes would yield a lower rate of abnormal @entity3538 than symptomatic codes, validating efforts to limit reimbursement in asymptomatic, low-yield groups. MATERIAL AND METHODS: We reviewed all outpatient @entity3538 done in 2011 at our institution. @entity66 codes were recorded, and each medical record was then reviewed by a vascular surgeon to determine if the assigned @entity66 code appropriately reflected the clinical scenario. @entity3538 findings categorized as abnormal (>50% stenosis) or normal (<50% stenosis) were recorded. Each individual @entity66 code and group 1 (asymptomatic), group 2 (nonhemispheric symptoms), group 3 (hemispheric symptoms), group 4 (preoperative cardiovascular examination), and group 5 (nonspecific) @entity66 codes were analyzed for correlation with @entity3538 results. RESULTS: Nine hundred ninety-four @entity1 had 74 primary @entity66 codes listed as indications for @entity3538 . Of assigned @entity66 codes, 17.4% were deemed inaccurate. Overall, 14.8% of @entity3538 were abnormal. Of the 13 highest frequency @entity66 codes, only 433.10, an asymptomatic code, was associated with abnormal @entity3538 . Four symptomatic codes were associated with normal @entity3538 ; none of the other high frequency codes were associated with @entity3538 result. @entity1 in group 1 (asymptomatic) were significantly more likely to have an abnormal @entity3538 compared to each of the other groups (P  <  0.001, P  <  0.001, P  =  0.020, P  =  0.002) and to all other groups combined (P  <  0.001). CONCLUSIONS: Asymptomatic indications by @entity66 codes yielded higher rates of abnormal @entity3538 than symptomatic indications. This finding is inconsistent with clinical experience and historical data, and we suggest that inaccurate coding may play a role. Limiting reimbursement for @entity3538 in low-yield groups is reasonable. However, reimbursement policies based on @entity66 coding, for example, limiting payment for asymptomatic @entity66 codes, may impede use of @entity3538 in high-yield @entity1 groups.

Reimbursement Policies for Carotid Duplex Ultrasound that are Based on XXXX Codes May Discourage Testing in High-Yield Groups.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity3538 :: ('MESH:D002341', 'Disease') :: ['CDU', 'carotid duplex ultrasound'] @entity66 :: ('MESH:D004194', 'Disease') :: ['incorrect or inappropriate ICD codes', 'ICD', 'International Classification of Diseases']
@entity66 :: (MESH:D004194,Disease) :: ['International Classification of Diseases']
