Categorization of a Universal Coding System to Distinguish Use of Durable Medical Equipment and Supplies in Pediatric Patients

Author:

Hotz Arda12,Sprecher Eli12,Bastianelli Lucia3,Rodean Jonathan4,Stringfellow Isabel1,Barkoudah Elizabeth56,Cohen Laurie E.78,Estrada Carlos910,Graham Robert1112,Greenwood Jonathan13,Kyle Jennifer14,Mann Nina215,Pinkham Maria13,Solari Toni16,Rosen Rachel216,Saleeb Susan217,Shah Ankoor S.1819,Watters Karen2021,Wells Sarah1,Berry Jay G.12

Affiliation:

1. Complex Care, Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts

2. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

3. Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts

4. Children’s Hospital Association, Lenexa, Kansas

5. Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts

6. Department of Neurology, Harvard Medical School, Boston, Massachusetts

7. Division of Pediatric Endocrinology & Diabetes, The Children’s Hospital at Montefiore, Bronx, New York

8. Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York

9. Department of Urology, Boston Children’s Hospital, Boston, Massachusetts

10. Department of Surgery, Harvard Medical School, Boston, Massachusetts

11. Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts

12. Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts

13. Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, Massachusetts

14. UnitedHealthcare, Minneapolis, Minnesota

15. Division of Nephrology, Boston Children’s Hospital, Boston, Massachusetts

16. Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts

17. Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts

18. Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts

19. Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts

20. Department of Otolaryngology, Boston Children’s Hospital, Boston, Massachusetts

21. Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts

Abstract

ImportanceAlthough durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES.ObjectiveTo categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence and related spending of DMES in pediatric patients using Medicaid.Design, Setting, and ParticipantsThis study is a cross-sectional analysis of the 2018 Merative Medicaid Database and included 4 569 473 pediatric patients aged 0 to 21 years enrolled in Medicaid in 12 US states from January 1 to December 31, 2018. Data were analyzed from February 2019 to April 2023.ExposureDMES exposure was identified with the Centers for Medicare & Medicaid Services HCPCS codes. Three pediatricians categorized HCPCS DMES codes submitted by vendors for reimbursement of dispensed DMES into DMES types and end-organ systems; 15 expert reviewers refined the categorization (2576 DMES codes, 164 DMES types, 14 organ systems).Main Outcomes and MeasuresThe main outcome was DMES prevalence & Medicaid spending. The χ2 test was used to compare DMES prevalence and Wilcoxon rank sum tests were used to compare per-member-per-year (PMPY) spending by complex chronic conditions (CCC).ResultsOf the 4 569 473 patients in the study cohort, 49.3% were female and 56.1% were aged 5 to 15 years. Patients used 133 of 164 (81.1%) DMES types. The DMES prevalence was 17.1% (95% CI, 17.0%-17.2%) ranging from 10.1% (95% CI, 10.0%-10.2%) in patients with no chronic condition to 60.9% (95% CI, 60.8%-61.0%) for patients with 2 or more CCCs. The PMPY DMES spending was $593, ranging from $349 for no chronic condition to $4253 for 2 or more CCCs. Lens (7.9%), vision frames (6.2%), and orthotics for orthopedic injury (0.8%) were the most common DME in patients with no chronic condition. Enteral tube / feeding supplies (19.8%), diapers (19.2%), lower extremity orthotics (12.3%), wheelchair (9.6%), oxygen (9.0%), and urinary catheter equipment (4.2%) were among the most common DMES in children with 2 or more CCCs.Conclusions and RelevanceIn this cross-sectional study, HCPCS distinguished a variety of DME types and use across pediatric populations. Further investigation should assess the utility of the HCPCS DMES categorization with efforts to optimize the quality and safety of DMES use.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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