Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims dataJudy A. Trevena A E , Kris D. Rogers B , Louisa R. Jorm B C , Tim Churches B and Bruce Armstrong B D
A NSW Ministry of Health, Locked Mail Bag 961, North Sydney, NSW 2059, Australia.
C Centre for Health Research, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia. Email: firstname.lastname@example.org
D School of Public Health, University of Sydney, Sydney, NSW 2006, Australia. Email: email@example.com
E Corresponding author. Email: firstname.lastname@example.org
Australian Health Review 37(5) 649-653 https://doi.org/10.1071/AH13092
Submitted: 7 May 2013 Accepted: 11 August 2013 Published: 28 October 2013
Objective We investigated the completeness of recording of pathology tests in Australian Medical Benefits Schedule (MBS) claims data, using the example of the prostate-specific antigen (PSA) test. With some exceptions, MBS claims data records only the three most expensive pathology items in an episode of care, and this practice (‘episode coning’) means that pathology tests can be under-recorded.
Methods The analysis used MBS data for male participants in the 45 and Up Study. The number and cost of items in each episode of care were used to determine whether an episode contained a PSA screening test (Item 66655), or could have lacked a record of this item because of episode coning.
Results MBS data for 1 070 392 episodes involving a request for a pathology test for 118 074 men were analysed. Of these episodes, 11% contained a request for a PSA test; a further 7.5% may have been missing a PSA request that was not recorded because of episode coning.
Conclusions It is important to consider under-reporting of pathology tests as a result of episode coning when interpreting MBS claims data. Episode coning creates uncertainty about whether a person has received any given pathology test. The extent of this uncertainty can be estimated by determining the proportion of episodes in which the test may have been performed but was not recorded due to episode coning.
What is known about the topic? Medical Benefits Schedule (MBS) claims data are a key resource for Australian health researchers.
What does this paper add? We investigated a feature of MBS claims data known as episode coning, which may cause some pathology tests to be under-reported. Using the example of requests for PSA tests, we estimated the uncertainty in the amount of use of PSA tests introduced by episode coning.
What are the implications for practitioners? Researchers using MBS data to identify use of specific pathology tests need to be aware of under-reporting caused by episode coning, and to estimate and report the uncertainty that this introduces into their findings.
References De Coster C, Quan H, Finlayson A, Gao M, Halfon P, Humphries KH, Johansen H, Lix LM, Luthi J-C, Ma J, Romano PS, Roos L, Sunderarajan V, Tu JV, Webster G, Ghali WA. Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium. BMC Health Serv Res 2006; 6 77
| Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium.CrossRef | 16776836PubMed |
 Goldsbury DE, Smith DP, Armstrong BK, O’Connell DL. Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study. BMC Health Serv Res 2011; 11 253 http://www.biomedcentral.com/1472-6963/11/253.
| Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study.CrossRef | 21978077PubMed |
 Newburn-Cook CV, Heaman M, Schopflocher D, Forget E, Jacobs P, Casiro O, Blanchard J, Sauve R, Roos LL. Direct medical costs of preterm birth from birth to age 7 years: a population-based study in Manitoba, Canada. Ann Epidemiol 2004; 14 610–1.
| Direct medical costs of preterm birth from birth to age 7 years: a population-based study in Manitoba, Canada.CrossRef |
 Byles JE, Dolja-Gore X, Loxton D, Parkinson L, Stewart Williams J. Women’s uptake of Medicare Benefits Schedule mental health items for general practitioners, psychologists and other allied mental health professionals. Med J Aust 2011; 194 175–9.
| 21401457PubMed |
 Jorm LR, Shepherd LC, Rogers KD, Blyth FM. Smoking and use of primary care services: findings from a population-based cohort study linked with administrative claims data. BMC Health Serv Res 2012; 12 263
| Smoking and use of primary care services: findings from a population-based cohort study linked with administrative claims data.CrossRef | 22900643PubMed |
 Australian Government Department of Health and Ageing. Medicare Benefits Schedule Book; 2011. Available from: http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/106E913240E19A0CCA257995007793EE/$File/201203-Cat%206.pdf [verified 14 June 2012]
 Medicare Australia. Medicare item reports. Available from: http://www.medicareaustralia.gov.au/statistics/mbs_item.shtml [verified 18 September 2013]
 Medical Benefits Reviews Task Group. Department of Health & Ageing: review of the funding arrangements for pathology services; 2011. Available from: http://www.qml.com.au/files/pathology_discussion_paper.pdf [verified 8 August 2012]
 45 and Up Study Collaborators Cohort profile: the 45 and Up Study. Int J Epidemiol 2007; 37 941–7.
| Cohort profile: the 45 and Up Study.CrossRef | 17881411PubMed |