Navigation

Home
Volume 38 Number 1: >>  Clinical Coding, Health Classification and Funding
 
Correlates of undefined cause of injury coded mortality data in Australia
Kirsten McKenzie, Linping Cheng and Susan M Walker p8
[ pdf ]

Abstract
The objective of this research was to identify the level of detail regarding the external causes of death in Australia and ascertain problematic areas where data quality improvement efforts may be focused. The 2003 national mortality dataset of 12,591 deaths with an external cause of injury as the underlying cause of death (UCOD) or multiple cause of death (MCOD) based on ICD-10 code assignment from death certificate information was obtained. Logistic regression models were used to examine the precision of coded external cause of injury data. It was found that overall, accidents were the most poorly defined of all intent code blocks with over 30% of accidents being undefined, representing 2,314 deaths in 2003. More undefined codes were identified in MCOD data than for UCOD data. Deaths certified by doctors were more likely to use undefined codes than deaths certified by a coroner or government medical office. To improve the quality of external cause of injuries leading to or associated with death, certifiers need to be made aware of the importance of documenting all information pertaining to the cause of the injury and the intent behind the incident, either through education or more explicit instructions on the death certificate and accompanying instructional materials. It is important that researchers are aware of the validity of the data when they make interpretations as to the underlying causes of fatal injuries and causes of injury associated with deaths.


The quality of injury data from hospital records in Vietnam.
Tran Thi Hong, Susan M Walker and Kirsten McKenzie p15
[ pdf ]

Abstract
The objective of this research was to examine the level of agreement of coders for ICD-10 coding of injury discharges in Danang General Hospital in Vietnam. Two hundred and five medical records of children hospitalised in this facility due to injury were randomly selected and recoded. Information from medical records abstracted by two trained staff was recoded by external coders in Hanoi and in Australia, using ICD-10. The completeness and detail of external cause of injury recorded in medical records was poor. Agreement between coders for injury coding was average, with 32% to 40% discrepancy in the main diagnosis codes at three character level, and 57% to 60% discrepancy at four character level, depending on which coders were being compared. It was concluded that as hospital data represent a cost-effective source of information regarding injuries, with significant costs incurred in collecting such information through special studies and censuses (especially for a developing country such as Vietnam), it is important to establish the quality and value of hospital data for injury surveillance and prevention research and to explore ways in which these data can be improved.


Do we have enough information? How ICD-10-AM Activity codes measure up.
Irene Hoi-Yen Soo, Mary K Lam, Julie Rust and Richard Madden  p22
[ pdf ]

Abstract
This research explored the usage of activity codes introduced into the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM) Third Edition and examined the data quality of activity coding, explicitly, completeness and specificity. Injury separations for years 2001/02 to 2005/06 specifying a ‘true injury’ were extracted for descriptive analyses. Part A investigated the usage of activity codes and compared the usage of the 236 activity codes available in the Activity block (U50-U73) present in the ICD-10-AM Third Edition against the 16 codes present in the second edition. Part B examined the level of completeness of external cause coding and the degree of activity coding specificity in the 2005/06 dataset. It was found that the additional activity codes were used extensively with only 46 codes seldom assigned. Codes present in the second edition were extensively used in the third and fourth editions and the new additional activity codes represent 10% of all activity codes assigned per year. All five datasets demonstrated high levels of completeness, recording completeness levels greater than 97%, where missing activity codes attributed to the majority of missing codes. Fourteen out of the 24 activity categories demonstrated a strong reliance on non-specific codes and Team ball sports and Wheeled non-motor sports illustrated that activity codes assigned lacked detail in the code. Clinicians and coders need to acknowledge the importance of quality clinical documentation for research and policy-making purposes so that circumstances surrounding injury events can be coded to the highest level of specificity to improve injury prevention and control activities. Missing activity codes and the abundance of non-specific coding hinders the usefulness of the data.

 
The risk and consequences of clinical miscoding due to inadequate medical documentation: A case study of the impact on health services funding.
Ping Cheng, Annette Gilchrist, Kerin M Robinson and Lindsay Paul  p35
[ pdf ]

Abstract
As coded clinical data are used in a variety of areas (e.g. health services funding, epidemiology, health sciences research), coding errors have the potential to produce far-reaching consequences. In this study the causes and consequences of miscoding were reviewed. In particular, the impact of miscoding due to inadequate medical documentation on hospital funding was examined. Appropriate reimbursement of hospital revenue in the casemix-based (output-based) funding system in the state of Victoria, Australia relies upon accurate, comprehensive, and timely clinical coding. In order to assess the reliability of these data in a Melbourne tertiary hospital, this study aimed to: (a) measure discrepancies in clinical code assignment; (b) identify resultant Diagnosis Related Group (DRG) changes; (c) identify revenue shifts associated with the DRG changes; (d) identify the underlying causes of coding error and DRG change; and (e) recommend strategies to address the aforementioned. An internal audit was conducted on 752 surgical inpatient discharges from the hospital within a six-month period. In a blind audit, each episode was re-coded. Comparisons were made between the original codes and the auditor-assigned codes, and coding errors were grouped and statistically analysed by categories. Changes in DRGs and weighted inlier-equivalent separations (WIES) were compared and analysed, and underlying factors were identified. Approximately 16% of the 752 cases audited reflected a DRG change, equating to a significant revenue increase of nearly AU$575,300. Fifty-six percent of DRG change cases were due to documentation issues. Incorrect selection or coding of the principal diagnosis accounted for a further 13% of the DRG changes, and missing additional diagnosis codes for 29%. The most significant of the factors underlying coding error and DRG change was poor quality of documentation. It was concluded that the auditing process plays a critical role in the identification of causes of coding inaccuracy and, thence, in the improvement of coding accuracy in routine disease and procedure classification and in securing proper financial reimbursement.


© 2009 Health Information Management Journal of the Health Information Management Association of Australia Ltd