Medicare Claims Sensitivity Low for Tumor Detection and Incomplete Colonoscopy

Researchers caution GI physicians when using Medicare claims data for important quality measures, in particular tumor detection and incomplete colonoscopy, as research results showed Medicare claims have low sensitivity for those diagnoses, according to a study published in Gastrointestinal Endoscopy.

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A team of researchers conducted a cross-sectional study of patients aged 65 and older undergoing colonoscopy. Patients’ colonoscopy records were linked to Medicare colonoscopy claims by patients’ age, sex, date of procedure and performing provider’s unique physician identification number.

Results showed 93.4 percent sensitivity and 97.8 percent specificity for claims for colon polyps. Claims for other GI diagnoses, including colorectal tumors and incomplete colonoscopy, showed “suboptimal” sensitivity.

Read the study about Medicare claims for GI diagnoses.

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