title: Barium enema and colonoscopy: appropriateness of utilization in a Medicaid population.
abstract: BACKGROUND
  To assess the appropriateness of utilization patterns for the barium enema and colonoscopy in a Medicaid population.
  
  
  METHODS
  From 1987 to 1991, a Medicaid managed-care database in Philadelphia revealed claims for a total of 2357 outpatient barium enemas and 896 outpatient colonoscopic examinations. The database was reviewed to determine the primary diagnostic (ICD-9-CM) codes assigned to patients who underwent these procedures. These codes were used as a proxy for indications. Each of the diagnostic codes for barium enema and colonoscopy was then classified either as appropriate, inappropriate, equivocal, or miscoded based on current guidelines in the medical literature.
  
  
  RESULTS
  A total of 1962 claims (83%) for barium enema were classified as appropriate, 126 (5%) as inappropriate, 84 (4%) as equivocal, and 185 (8%) as miscoded, whereas 645 claims (72%) for colonoscopy were classified as appropriate, 176 (20%) as inappropriate, 65 (7%) as equivocal, and 10 (1%) as miscoded. Thus, significantly more colonoscopic examinations were rated as inappropriate (p < 0.001).
  
  
  CONCLUSIONS
  Our study suggests that more stringent criteria need to be used by physicians in ordering diagnostic examinations of the colon, particularly colonoscopy. Further investigation of the appropriateness of these procedures and the development and dissemination of guidelines seems warranted.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Levine
authors.forename: S
authors.initials: S
authors.lastname: Sor
authors.forename: D
authors.initials: D
authors.lastname: Yin
authors.forename: C P
authors.initials: CP
authors.lastname: Langlotz
authors.forename: D
authors.initials: D
authors.lastname: Bachwich
mesh_terms: D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data*; D004733:Enema; D006300:Health Services Misuse; D006801:Humans; D008484:Medicaid; D012189:Retrospective Studies; D014481:United States
chemical_list: D001466:Barium Sulfate