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Inappropriate PCIs decrease as practices shift
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Declines in inappropriate PCIs may be associated with shifts in coding and/or diagnostic practices, according to a study published in JAMA Internal Medicine.
Rishi K. Wadhera, MD, MPP, MPhil, clinical fellow in medicine at Brigham and Women’s Hospital, and colleagues analyzed data from 615,649 inpatient and outpatient PCIs performed in Michigan, New York and Florida from 2010 to 2014. Researchers classified PCIs as acute if they were linked to a primary or secondary diagnosis of unstable angina or an acute MI.
“Percutaneous coronary interventions performed for [acute] MI and [unstable angina] in an outpatient setting should be infrequent and remain stable over time — a significant increase would suggest potential shifts in diagnostic and/or coding patterns,” Wadhera and colleagues wrote.
From 2010 to 2014, the proportion of outpatient PCIs that were coded for acute indications increased in Michigan (2.4% to 6.5%), New York (0.6% to 8.3%) and Florida (2.4% to 3.8%). This increase was related to a rise in the crude number of outpatient PCIs that were coded for unstable angina, which was seen in Michigan (587 to 1,426), New York (242 to 3,179) and Florida (1,231 to 1,686).
Although the number of acute MI codes for outpatient PCIs were lower, they also increased in Michigan (90 to 162), New York (49 to 435) and Florida (134 to 192).
PCIs in the inpatient setting that were coded for acute indications increased in Michigan and Florida.
“Further study is needed to understand the rise in outpatient PCIs coded for [unstable angina]. These data also highlight the need for developing mechanisms to more accurately assess PCI appropriateness,” Wadhera and colleagues wrote.
“The rationale for upcoding of [unstable angina] remains unclear but very concerning,” Christian A. McNeely, MD, resident physician at Barnes-Jewish Hospital/Washington University Medical Center in St. Louis, and David L. Brown, MD, FACC, professor of medicine at Washington University School of Medicine in St. Louis, wrote in a related editorial. “The [appropriate use criteria] were intended for internal quality improvement and benchmarking by PCI programs. Thus, without public disclosure of the appropriateness of procedures performed by individual hospitals or cardiologists, there is no motive for upcoding to improve the public perception of quality and enhance referrals. Furthermore, since the indication for PCI (stable angina vs. [unstable angina]) does not affect reimbursement, differential payment is unlikely to explain upcoding. A more likely albeit troublesome explanation could be to justify performance of PCI inpatients who may not need the procedure.” – by Darlene Dobkowski
Disclosures: Wadhera reports he is supported by an NIH training grant and Brigham and Women’s Hospital and has previously served as a consultant for Sanofi and Regeneron. McNeely and Brown report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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