Accuracy of Billing Codes Used in the Therapeutic Care of Diabetic Retinopathy

In JAMA Ophthalmology, Marisa Lau and colleagues, including Brian VanderBeek, seek to determine the accuracy of diagnostic, procedural, and therapeutic billing codes used in the treatment of diabetic retinopathy. As insurance billing claim databases represent a growing field of scientific inquiry within ophthalmology, validating the accuracy of billing claim codes is of increasing importance. The authors conducted a retrospective medical record review at three clinical practices, examining each patient’s billing data and medical record, measuring positive and negative predictive values of each code. They find that nearly all frequently used codes of interest had a high positive predictive value (PPV) and negative predictive value (NPV), meaning the codes were more likely to be accurate. Less frequently used codes were usually accurate, with the exception of two – one of which had a low PPV, and one of which had a low sensitivity to the desired code. These data suggest that diagnostic, procedure, and therapeutic codes derived from insurance billing claims accurately reflect the medical record for patients with diabetic retinopathy.