Sounding the Alarm About False Positives

There are false negatives; there are false positives; there are untested individuals with disease.

 I am in the process of developing a 90-minute COVID-19 webinar for ICDUniversity in December to outline new codes and updates, and my inbox is replete every day with articles about the coronavirus.

On Sunday, I took a walk with my husband and had to grab a surgical mask from his stash in his car, because all my handsewn masks were in the wash. I had to take it off after a short while, because it smelled so vile that it literally made me want to vomit. He donned it and assured me that that was what those masks always smell like.

The Cleveland Clinic no longer allows providers to wear homemade or store-bought masks; they are mandated to wear surgical masks, although an email from them just this morning encouraged the general population to wear a cloth mask or face covering when out. Thank goodness I no longer practice clinically!

How this relates to the topic at hand is that a study came out recently, produced by 13 academic medical centers in 12 states, noting that 6 percent of 3,248 participants had SARS-CoV-2 antibodies even though they had not been aware of contracting COVID-19. The findings also showed that:

  • Healthcare providers (HCPs) who reported always wearing face coverings when interacting with patients had lower seroprevalence than those who did not; and
  • HCPs who reported a shortage of personal protective equipment (PPE) at their medical centers were more likely to have detectable antibodies than those who had ample supplies.

Forty-four percent of the approximately 195 members of the serology-positive group “did not believe that they had previously had COVID-19.” I wondered, were some of these false positive antibody tests? This reminded me of other instances of false positives in the news, such as with professional sports teams and at colleges. I’m quite attuned to this ever since my father’s false=positive PCR testing debacle.

This led me to research false positives in PCR testing, and I found an article in The Lancet noting that false-positive COVID-19 tests in the United Kingdom are becoming increasingly likely, with substantial consequences at the personal, health system, and societal levels. It makes sense – more testing, even with a low false-positive rate, will lead to more false positives by the law of numbers.

One of the references from The Lancet article was another article centering on the false discovery rate, which is the proportion of positive test results that are false positive, and its relationship to prevalence, which is the percentage of population currently infected. If the positivity rate is low, even a small false-positive rate can produce a large false discovery rate.

I am really hesitant to sound too loud an alarm about false positives. I would rather have people take a false positive test seriously than have a person with asymptomatic COVID-19 spreading it around because they blew off a positive test as being incorrect. I am afraid, however, that the statistics about COVID-19 are somewhat inaccurate. There are false negatives; there are false positives; there are untested individuals with disease.

The death rate may be inaccurate, but over 230,000 people have died in the U.S. For every person who dies, 19 more have required hospitalization. Many of those will have permanent or long-lasting heart, lung, or neurological damage, including strokes. It is important to remember that COVID-19 isn’t a binary “dead” or “fully recovered” situation.

The studies are incontrovertible in that wearing face coverings save lives. If 95 percent of us wore masks, the total number of deaths would drop by almost half. Vaccines aren’t immediately forthcoming, and adoption of vaccination is likely to be feeble. A large World Health Organization (WHO) study just came out suggesting that remdesivir, one of the drugs which President Trump received when he had COVID-19, does not reduce mortality.

Thanksgiving and Christmas are coming. It is going to be a long, hard winter. Listen to the science, Tony Fauci, and me: practice handwashing, crowd avoidance, physical distancing, and wearing a mask over your nose and mouth. Stay safe.

Programming Note: Listen to Dr. Erica Remer report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.

Facebook
Twitter
LinkedIn

Erica Remer, MD, FACEP, CCDS, ACPA-C

Erica Remer, MD, FACEP, CCDS, ACPA-C has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals.  Don’t miss this chance to protect your hospital’s revenue and reputation!

May 29, 2025
I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025
2025 Coding Clinic Webcast Series

2025 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 14, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24