Background
Methods
Data source and study population
Preliminary case identification
Algorithm development and claims profile review
Algorithm Variables | Code Type | Code |
---|---|---|
Goiters/Nodules Diagnosis | ICD-9 Diagnosis | 226, 237.4, 240.x, 241.x, 242.xx, 246.1, 246.2 |
Levothyroxine | HICL | 002849 |
Thyroid surgery (partial or total thyroidectomy) | CPT-4 | 60200, 60210, 60212, 60220, 60225, 60240, 60242 60245, 60246, 60252, 60254, 60260, 60261, 60270, 60271 |
ICD-9 Procedure | 06, 06.2 ,06.3x, 06.4, 06.5x, 06.6 | |
Chemotherapy | CPT-4 | 96400, 96408, 96410, 96412, 96414, 96420, 96422, 96423, 96425, 96440, 96445, 96450, 96500, 96501, 96504, 96505, 96508, 96509, 96510, 96511, 96512, 96524, 96526, 96535, 96538, 96540, 96542, 96545, 96549 |
HCPCS | C8953, G9021, G9025, S5020, S9329 | |
Radio-iodine therapy | HCPCS | A9517, A9525, A9530, A9545, Q0105, Q0106, Q0107, Q9945, Q9946, Q9948, Q9951, Q9958, Q9959, Q9960, Q9961, Q9962, Q9963, Q9964 |
HICL | 000747, 000748, 009223, 025482, 036581 | |
Radiation therapy | HCPCS | X7945, G0173, G0174, G0178, G0179, S8049 |
CPT-4 | 76950, 76965, 77261, 77262, 77263, 77280, 77285, 77290, 77295, 77299, 77300, 77301, 77305, 77310, 77315, 77321, 77326, 77327, 77328, 77331, 77332, 77333, 77334, 77336, 77338, 77370, 77371, 77372, 77373, 77380, 77381, 77399, 77401, 77402, 77403, 77404, 77406, 77407, 77408, 77409, 77411, 77412, 77413, 77414, 77416, 77417, 77418, 77419, 77420, 77421, 77422, 77423, 77425, 77427, 77430, 77431, 77432, 77435, 77470, 77499, 77520, 77522, 77523, 77525, 77750, 77761, 77762, 77763, 77776, 77777, 77778, 77781, 77782, 77783, 77784, 77785, 77786, 77787, 77789, 77790, 77799, 79000, 79001, 79005, 79020, 79030, 79035, 79100, 79101, 79200, 79300, 79400, 79403, 79420, 79440, 79445, 79999 | |
ICD-9 Procedure | 92.2, 92.20, 92.21, 92.22, 92.23, 92.24, 92.25, 92.26, 92.27, 92.28, 92.29, 92.3, 92.30, 92.31, 92.32, 92.33, 92.39, 92.4, 92.41 |
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Claim for thyroid goiter/nodule
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No dispensings of levothyroxine
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Any claim with ICD-9 193 (includes claims for inpatient/outpatient visits, screenings, laboratory tests, procedures)
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Any inpatient or outpatient visit claim with ICD-9 193
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Primary inpatient claim with ICD-9 193
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No claims with diagnosis of benign thyroid nodule ≤60 days after a claim with ICD-9 193
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≥1 claim for thyroid surgery (partial or total thyroidectomy)
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≥1 claim for any non-surgical treatment for TC (e.g., chemotherapy, radio-iodine therapy, radiation therapy)
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≥1 claim any TC treatment (non-surgical or surgical)
Outcome adjudication
Algorithm development
Data analysis
Results
Adjudicated Status | |||||||||
---|---|---|---|---|---|---|---|---|---|
Algorithm components identified from claims | Total | Cases | Non-Cases | Positive Predictive Value (PPV) | 95% CI | Sensitivitya
| 95% CI | Specificityb
| 95% CI |
a) ≥ 1 claim with ICD-9 193 | 141 | 72 | 69 | 51% | 43-60 | 100% | 94-100 | 0% | 0-7 |
b) Any inpatient or outpatient claim with ICD-9 193 | 119 | 68 | 51 | 57% | 48-66 | 94% | 86-98 | 26% | 17-38 |
c) Primary inpatient claim with ICD-9 193 | 21 | 12 | 9 | 57% | 34-77 | 17% | 09-28 | 87% | 76-93 |
d) Claim for goiter in baseline | 49 | 30 | 19 | 61% | 46-74 | 42% | 30-54 | 72% | 60-82 |
e) No dispensings for levothyroxine in baseline | 104 | 62 | 42 | 60% | 50-69 | 86% | 75-93 | 39% | 28-52 |
f) No claims with diagnosis of benign thyroid nodule ≤ 60 days after ICD-9 193 | 123 | 69 | 54 | 56% | 47-65 | 96% | 87-99 | 22% | 13-34 |
g) Claims for thyroid surgery in follow-up | 103 | 70 | 33 | 68% | 58-77 | 97% | 89-100 | 52% | 40-64 |
h) Claims for any non-surgical treatment (chemo, radio-iodine, radiation) | 40 | 38 | 2 | 95% | 82-99 | 53% | 41-65 | 97% | 89-99 |
i) Any treatment (non-surgical or thyroid surgery) | 104 | 71 | 33 | 68% | 58-77 | 99% | 91-100 | 52% | 40-64 |
Algorithms | |||||||||
1) Thyroid surgery and no baseline levothyroxine | 90 | 60 | 30 | 67% | 56-72 | 83% | 72-93 | 57% | 44-68 |
2) Thyroid surgery and ≥2 ICD-9 193 codes ≤ 90 days after surgery | 68 | 62 | 6 | 91% | 81-96 | 86% | 75-93 | 91% | 81-96 |