Coding Variability in Genetic Testing

A summary of coding and pricing variation in commercial health insurance claims

The quantity, variety, and complexity of clinical genetic tests on the market have grown rapidly over the last decade. The elimination of patent protection on human genes, the proliferation of next-generation sequencing (NGS) technology, and the rapid discovery of gene-disease connections have all contributed to this trend.

This paper explores one result of this growth: Variation in the application of billing codes for commercial insurance reimbursement.

Concert analyzed 2.2 million commercial genetic testing claims from 2016-2018, representing a population of more than 35 million lives, to quantify how uniformly (or variably) billing codes are being applied in commercial insurance reimbursement.

Figures include:

  1. Average number of codes per claim by domain of genetic testing
  2. Number of distinct code signatures observed within each domain
  3. Standard deviation of reimbursements observed within each domain
  4. Correlation between code variation and price variation

Concludes with a discussion of the impact of coding and price variation on key stakeholders in the Genetic Health Information Network.

To access the counterpart to this paper, see: Coding Solution for Genetic Testing: A coding engine for accurate and consistent coding of genetic tests

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