CMS's description of Medicare data provided to CBS News

  • CBS FOIA Data Request

    Overview:

    CBS News has submitted a FOIA data request for information on the number of physicians performing spinal fusion surgeries in calendar year 2011 through calendar year 2012. The data request uses 100% of the fee-for-service physician/supplier claims summarized to the physician performing National Provider Identifier (NPI). The claims data originate from the Chronic Condition Warehouse (CCW) Part B non-institutional claims extracted from the oracle database as of September 2013.

    File Contents:

    Final product will include the following information on each performing NPI that bills for lumbar fusion surgery in calendar year 2011 through calendar year 2012.

    Physician NPI -National Provider Identifier (NPI) issued by the National Plan & Provider Enumeration System (NPPES) restricted to physicians with specialties in Orthopaedic, Neurological and Physical Medicine & Rehabilitation (specialty codes 20, 14, and 25).

    Medicare Beneficiaries - Count of all unique Medicare beneficiaries serviced by the physician for any type of service.

    Lumbar Fusion Surgeries - Count of overall lumbar surgeries defined by HCPCS procedure codes 22558, 22585, 22586, 22612, 22614, 22630, 22632, 22633, 22634.

    Medicare Lumbar Fusion Surgery Beneficiaries -Count of unique Medicare beneficiaries having lumbar fusion surgeries defined by HCPCS procedure codes 22558, 22585, 22586, 22612, 22614, 22630, 22632, 22633, 22634.

    Medicare Lumbar Fusion Surgery Beneficiaries with 3+ Surgeries -Count of unique Medicare beneficiaries having 3 or more lumbar fusion surgeries defined by HCPCS procedure codes 22558, 22585, 22586, 22612, 22614, 22630, 22632, 22633, 22634.

    Multi Level Lumbar Fusion Surgeries Performed on 2 or More [Additional] Levels - Count of multi-level lumbar fusion surgeries defined by HCPCS procedure codes 22585, 22614, 22632, and/or 22634 where at least one of the HCPCS codes is duplicated on the same procedure.

    Medicare Multi Level Lumbar Fusion Surgery Performed on 2 or More [Additional] Levels Beneficiaries - Count of unique Medicare beneficiaries having multi level lumbar fusion surgeries defined by HCPCS procedure codes 22585, 22614, 22632, and/or 22634 where at least one of the HCPCS codes is duplicated on the same procedure.

    Programming/Analysis Procedures:

    1) Extract HCPCS specific line-item records from the 100% NCH physician/supplier files, for calendar year 2011 and calendar year 2012. Include HCPCS Codes 22558, 22585, 22586, 22612, 22614, 22630, 22632, 22633, 22634.

    2) Screen all data by omitting any HCPCS codes associated with modifiers: 53, 55, 66, 73, 74, 80, 81, 82, AK, and AS. Restrict data to physicians with specialty codes 20, 25 and 14.

    3) Collapse claims data into unique surgery counts required in the final excel spreadsheets.

    4) Summarize the surgery and beneficiary counts to the physician performing NPI.

    5) Rematch the physician performing NPIs from step 4 back to the 100% NCH physician/supplier data in order to calculate all Medicare fee-for-service beneficiaries per physician performing NPI.

    6) To reduce the risk in re-identification of Medicare beneficiaries, mask both the surgery count and beneficiary count information based on beneficiary counts fewer than 11 and/or where Medicare payments for spinal surgeries make up 90% or more of the total Medicare payments for a given physician performing NPI.

    7) Export final file to Excel.

    [This write-up was edited to include only the data published in this story. More information was provided]

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