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