Early Survey of National Claims-Made Database Finds No Paid Claims for Robotic Surgery
by John Otrompke
An early review of a robust claims database maintained by an association of physician insurance companies reveals no paid claims based on robotic surgery, according to spokespersons for the Physicians Insurance Association of America (PIAA).
However, due to the nature of litigation, as well as claims databases (which are based on litigation), caution may be called for in interpreting the positive preliminary results, according to Divya Parikh, MPH, director of research and loss prevention at the PIAA.
Since the ICD-9 codes for billing for medical procedures were amended in 2008 to includes codes 17.41 to 17.49 for robotic surgery procedures, one single claim was made following robotic surgery, but the claim was closed without being paid, explained Kwon Miller, PIAA data analyst. There were no open claims up to the end of 2010, according to Parikh.
The PIAA databasem established in 1985, is considered robust, comprising companies that insure as many as 60% of physicians practicing in the United States, Parikh said. All told, about 260,000 claims are contained within the database.
"It's nice to see this, but it isn't highly unusual, because of the long tail effect wuith insurance; it can take up to four years to close a claim in some jurisdictions, and many times we don't see a claim for five to ten years," Parikh said.
"In addition, we may not be capturing data from solo physicians; the physicians in the database may not even be performing these procedures," she added. The database does not currently incude data from doctors in Physician-Hospital Organizations (PHOs), Parikh said.
"Another problem is that we use the ICD-9 manual, which is used for billing," according to Parikh. For claims made prior to 2008, the database includes claims for procedures such as radical prostatectomy, sacrocolpopexy, and mitral valve repair, which may be performed in a minimally invasive manner. However, the minimally invasive procedures included both robotic and laparscopic procedures prior to 2008, and they were not broken down into the categories, she said.
The database was established in 1985, Miller said. "For each claim, we identify a person's condition, and what the doctor performed, then another field shows the alleged error," she added. Of the 260,000 claims in the database, only about 72,000 resulted in an indemnity payment, Miller said.
Therein lies the original raison d'etre for the database, Parikh said. "Only one third of claims or less result in a payment, which is why the PIAA database exists. This shows why there is an increase in defense costs. Sometimes the numbers shift to even less claims paid, sometimes going down as low as 26%," she explained.
An early review of a robust claims database maintained by an association of physician insurance companies reveals no paid claims based on robotic surgery, according to spokespersons for the Physicians Insurance Association of America (PIAA).
However, due to the nature of litigation, as well as claims databases (which are based on litigation), caution may be called for in interpreting the positive preliminary results, according to Divya Parikh, MPH, director of research and loss prevention at the PIAA.
Since the ICD-9 codes for billing for medical procedures were amended in 2008 to includes codes 17.41 to 17.49 for robotic surgery procedures, one single claim was made following robotic surgery, but the claim was closed without being paid, explained Kwon Miller, PIAA data analyst. There were no open claims up to the end of 2010, according to Parikh.
The PIAA databasem established in 1985, is considered robust, comprising companies that insure as many as 60% of physicians practicing in the United States, Parikh said. All told, about 260,000 claims are contained within the database.
"It's nice to see this, but it isn't highly unusual, because of the long tail effect wuith insurance; it can take up to four years to close a claim in some jurisdictions, and many times we don't see a claim for five to ten years," Parikh said.
"In addition, we may not be capturing data from solo physicians; the physicians in the database may not even be performing these procedures," she added. The database does not currently incude data from doctors in Physician-Hospital Organizations (PHOs), Parikh said.
"Another problem is that we use the ICD-9 manual, which is used for billing," according to Parikh. For claims made prior to 2008, the database includes claims for procedures such as radical prostatectomy, sacrocolpopexy, and mitral valve repair, which may be performed in a minimally invasive manner. However, the minimally invasive procedures included both robotic and laparscopic procedures prior to 2008, and they were not broken down into the categories, she said.
The database was established in 1985, Miller said. "For each claim, we identify a person's condition, and what the doctor performed, then another field shows the alleged error," she added. Of the 260,000 claims in the database, only about 72,000 resulted in an indemnity payment, Miller said.
Therein lies the original raison d'etre for the database, Parikh said. "Only one third of claims or less result in a payment, which is why the PIAA database exists. This shows why there is an increase in defense costs. Sometimes the numbers shift to even less claims paid, sometimes going down as low as 26%," she explained.
posted by John J. Otrompke | 8:48 PM
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