v1.1 –June 2020:
This updated version contains refinements to the coding algorithm, resulting in greater clarity and simplification of coding for genetic testing. The previous version can be accessed here.
The genetic testing market is growing fast and evolving rapidly. With more than 150,000 clinically orderable genetic tests on the market, stakeholders are struggling to communicate effectively and efficiently across the Genetic Health Information Network. One significant challenge is coding genetic tests for reimbursement. This is seen in claims data, where variation in coding correlates with variation in pricing.
Concert has developed a novel method to translate a genetic test into a single code or code combination. This paper describes this method, the Concert Coding Engine, including the objectives, guiding principles, data inputs, underlying logic, and the limitations of the current implementation.
The paper concludes with a brief discussion on how stakeholders may access and deploy the Concert Coding Engine.
To access the counterpart to this paper, see: Coding Variability in Genetic Testing: A summary of coding and pricing variation in commercial health insurance claims