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The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care

The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care
The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care

Background: coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. 

Methods: comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 

Results: 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p < 0.0001) or coded from the discharge summary with medical support (70% vs 60% respectively, p < 0.0001). When compared with the gold standard, the percentage of incorrect HRGs was 42% for discharge summary alone, 31% for coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. 

Conclusion: the accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries.

Clinical coding and quality of health care, Data accuracy, Diagnosis
1386-5056
35-42
Tsopra, Rosy
3741a138-0b19-4ed3-a96c-1df7338c22c1
Peckham, Daniel
e22cccc4-790e-445b-803e-9ade010384cf
Beirne, Paul
962c2183-a978-4278-8866-09cfbca46928
Rodger, Kirsty
f2e4ebbe-c720-40a5-915b-fe5ed1bc77c3
Callister, Matthew
0a1d4b62-4f9e-4375-885d-ce7bdba6d73e
White, Helen
39b5696d-3e64-4af5-b229-e36024543e03
Jais, Jean Philippe
55266cf8-96dd-4175-8d80-1b5981b2bc2e
Ghosh, Dipansu
eb9d45b8-633c-4293-a8e2-997c00279916
Whitaker, Paul
ee3c6e66-801f-4b46-aa08-e87c3eadd07d
Clifton, Ian J.
d5677cec-7406-4f6a-92a6-5e2b2670ba54
Wyatt, Jeremy C.
8361be5a-fca9-4acf-b3d2-7ce04126f468
Tsopra, Rosy
3741a138-0b19-4ed3-a96c-1df7338c22c1
Peckham, Daniel
e22cccc4-790e-445b-803e-9ade010384cf
Beirne, Paul
962c2183-a978-4278-8866-09cfbca46928
Rodger, Kirsty
f2e4ebbe-c720-40a5-915b-fe5ed1bc77c3
Callister, Matthew
0a1d4b62-4f9e-4375-885d-ce7bdba6d73e
White, Helen
39b5696d-3e64-4af5-b229-e36024543e03
Jais, Jean Philippe
55266cf8-96dd-4175-8d80-1b5981b2bc2e
Ghosh, Dipansu
eb9d45b8-633c-4293-a8e2-997c00279916
Whitaker, Paul
ee3c6e66-801f-4b46-aa08-e87c3eadd07d
Clifton, Ian J.
d5677cec-7406-4f6a-92a6-5e2b2670ba54
Wyatt, Jeremy C.
8361be5a-fca9-4acf-b3d2-7ce04126f468

Tsopra, Rosy, Peckham, Daniel, Beirne, Paul, Rodger, Kirsty, Callister, Matthew, White, Helen, Jais, Jean Philippe, Ghosh, Dipansu, Whitaker, Paul, Clifton, Ian J. and Wyatt, Jeremy C. (2018) The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care. International Journal of Medical Informatics, 115, 35-42. (doi:10.1016/j.ijmedinf.2018.03.015).

Record type: Article

Abstract

Background: coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. 

Methods: comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 

Results: 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p < 0.0001) or coded from the discharge summary with medical support (70% vs 60% respectively, p < 0.0001). When compared with the gold standard, the percentage of incorrect HRGs was 42% for discharge summary alone, 31% for coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. 

Conclusion: the accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries.

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More information

Accepted/In Press date: 26 March 2018
e-pub ahead of print date: 27 March 2018
Published date: 1 July 2018
Keywords: Clinical coding and quality of health care, Data accuracy, Diagnosis

Identifiers

Local EPrints ID: 421705
URI: https://eprints.soton.ac.uk/id/eprint/421705
ISSN: 1386-5056
PURE UUID: 5604a486-11c2-439f-a623-9e1a613631f6
ORCID for Jeremy C. Wyatt: ORCID iD orcid.org/0000-0001-7008-1473

Catalogue record

Date deposited: 21 Jun 2018 16:30
Last modified: 20 Jul 2019 04:18

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