Table 4 Odds of favorable prior authorization outcome when submitted with diagnostic codes.
Test type, diagnostic category (ICD-10-CM) | ICD code present | ICD code absent | Odds of favorable outcome with diagnostic code present,a odds ratio (95% confidence interval) | p value |
|---|---|---|---|---|
Exome sequencing | ||||
Autism (F84.0) | 80/114 (70.2%) | 443/659 (67.2%) | 1.15 (0.74–1.77) | 0.534 |
Developmental delay (F80.4, F82, F88, F80.9, R62.50) | 189/290 (65.2%) | 334/483 (69.2%) | 0.83 (0.61–1.14) | 0.252 |
Intellectual disability (F79, F70–78, F81.9) | 43/65 (66.2%) | 480/708 (67.8%) | 0.93 (0.54–1.59) | 0.786 |
Seizures and epilepsy (G40–40.919) | 22/35 (62.9%) | 501/738 (67.9%) | 0.80 (0.40–1.62) | 0.534 |
Multiple congenital anomalies (Q89.7) | 22/33 (66.7%) | 501/740 (67.7%) | 0.95 (0.46–2.00) | 0.901 |
CMA | ||||
Autism (F84.0) | 241/260 (92.7%) | 1,145/1,307 (87.6%) | 1.79 (1.09–2.94) | 0.019 |
Developmental delay (F80.4, F82, F88, F80.9, R62.50) | 489/548 (89.2%) | 897/1,019 (88.0%) | 1.13 (0.81–1.57) | 0.476 |
Intellectual disability (F79, F70–78, F81.9) | 120/134 (89.6%) | 1,266/1,433 (88.3%) | 1.13 (0.64–2.01) | 0.676 |
Seizures and epilepsy (G40–40.919) | 31/38 (81.6%) | 1,355/1,529 (88.6%) | 0.57 (0.25–1.31) | 0.180 |
Multiple congenital anomalies (Q89.7) | 52/57 (91.2%) | 1,334/1,510 (88.3%) | 1.37 (0.54–3.48) | 0.504 |
