How Much Is the Cost of Coding Errors?

Dr. Siti Athirah Zafirah, Prof Emeritus Dr. Syed Mohamed Aljunid

Description

Casemix system or Diagnosis-Related Groups (DRGs) has been implemented in UKM-Medical Centre, currently known as Hospital Canselor Tuanku Muhriz UKM, since 2002 with the deployment of a locally developed MY-DRG casemix grouper. Coding of diagnosis and procedures using ICD-10 and ICD9-CM are among the major variables required for optimum implementation of casemix system. The impact of coding errors on hospital revenue and budget has rarely been assessed in countries that implement casemix system for provider's reimbursement. This book reports an outcome of the first study done in Malaysia to quantify the economic losses due to coding errors. A blinded re-coding process was conducted to evaluate the quality of clinical coding of randomly selected patient medical records from four major specialities in the hospital: Medical, Surgical, Paediatrics and Obstetrics & Gynaecology. The rates of overall coding errors were identified, and the different types of coding errors were analysed and reported in detail. The amount of losses in hospital revenue due to coding errors were estimated in the study. Factors that led to the coding errors of diagnoses and procedures were analysed and presented in this book. It is hope that results of this unique research reported in this book would encourage leaders in hospital services to pay serious attention on the problems and embark on intensive and continues training of coders and other clinical staff to effectively reduce the coding errors in the implementation of casemix system.

Sujets

• Médecine
• Médecine Générale
• Medical
• Cost

Informations

• Publié par: Partridge Publishing Singapore
• Date de parution: 24 mars 2023
• Nombre de lectures: 0
• EAN13: 9781543773002
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

HOW MUCH IS THE COST OF CODING ERRORS?
A Study on Factors Influencing Quality of Clinical Coding in Implementation of MY-DRGs Casemix System in Hospital Services
PROFESSOR EMERITUS DR SYED MOHAMED ALJUNID AND DR SITI ATHIRAH ZAFIRAH


Copyright © 2023 by Professor Emeritus Dr Syed Mohamed Aljunid & Dr Siti Athirah Zafirah
 
ISBN:
Softcover
978-1-5437-7299-9

eBook
978-1-5437-7300-2
 
All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.
 
Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.
 
 
 
 
 
 
www.partridgepublishing.com/singapore
Contents
List of Abbreviations
Acknowledgement
Chapter 1Introduction
1.1Introduction
1.2Study Background
1.3DRGs and Coding Process
1.4Problem Statements
1.5Research Objectives
1.5.1General Objective
1.5.2Specific Objectives
1.6Hypothesis
1.7Study Justification
1.8Conceptual Framework
Chapter 2Literature Review
2.1Introduction
2.2Healthcare Financing
2.3Casemix System
2.4Diagnosis Related Group (DRG)
2.5Clinical Coding
2.5.1Clinical Coding Process
2.5.2Steps in Assigning Codes
2.5.3The Coders
2.6Clinical Coding Errors
2.6.1Type of Clinical Coding Errors
2.6.2Factor Influencing the Clinical Coding Errors
2.7Improving the Quality of Coding
2.8Implications of Clinical Coding Errors
Chapter 3Methodology
3.1Introduction
3.2Study Background
3.3Study Design
3.4Sample Unit
3.5Sampling Method
3.5.1PMR
3.5.2Coders
3.5.3Doctors
3.6Sample Size Calculation
3.7Inclusion And Exclusion Criteria
3.7.1Inclusion Criteria for PMR
3.7.2Exclusion Criteria for PMR
3.8Study Tools
3.8.1PMR
3.8.2Data Abstraction Sheet
3.8.3Checklist for 14 Casemix Variables
3.8.4Survey Form on Clinical Coder’s Demographic Data
3.8.5Information Sheet on Doctor’s Demographic Data
3.8.6MY-DRG® Grouper
3.8.7Procedure of Data Collection
3.9Methodology of the Re-Coding Process
3.10Definition of Coding Errors
3.11Definition of the Type of Coding Errors
3.11.1Type of Coding Errors in Primary Diagnosis Code
3.11.2Type of Coding Errors in Secondary Diagnosis Code
3.11.3Type of Coding Errors in Primary Procedure Code
3.11.4Type of Coding Errors in Secondary Procedure Code
3.12Data Analysis
3.12.1Data Analysis on the Incidence of Clinical Coding Errors in UKMMC
3.12.2Data Analysis on the Economic Impact of Coding Errors
3.13Variables
3.13.1Dependent Variables
3.13.2Independent Variables
3.14Variables Operational Definition
3.14.1Dependent Variables
3.14.2Independent Variables
Chapter 4Results
4.1Introduction
4.2Profile of Patients
4.3Coding Errors Rate in UKMMC
4.3.1Coding Errors in Primary Diagnosis Code
4.3.2Coding Errors of Secondary Diagnosis Code
4.3.3Coding Errors of Primary Procedure Code
4.3.4Coding Errors of Secondary Procedure Code
4.4Coding Erros by Case-Type
4.4.1Coding Errors of Medical Case-Type
4.4.2Coding Errors of Surgical Case-Type
4.4.3Coding Errors of O&G Case-Type
4.4.4Coding Errors of Paediatric Case-Type
4.5Coding Errors by Severity Level
4.6Coding Errors by Type of CMG
4.7Coding Errors by MY-DRG® Groups
4.8Coding Errors by Completeness of Admission Form
4.9Coding Errors by Completeness of Discharge Summary
4.10Coding Erros by Coder’s Characteristic
4.11Coding Errors by Doctor’s Characteristic
4.12Multiple Logistic Regression on Factors Influencing Coding Errors
4.13UKMMC’s Potential Hospital Revenue
4.13.1Total Potential Hospital Revenue by Case-Type
4.13.2Total Potential Hospital Revenue by Severity Level
4.13.3Top 10 MY-DRG® with Highest Total Potential Hospital Revenue
4.13.4Top 10 CMGs With Highest Total Potential Hospital Revenue
4.14Bivariate Analyses on Factors Influencing Loss of Potential Hospital Revenue in Casemix System
4.14.1Association between Coding Errors of Primary Diagnosis Code and Potential Loss of Hospital Revenue
4.14.2Association between Coding Errors of Secondary Diagnosis Code Potential Loss of Hospital Revenue
4.14.3Association between Coding Errors of Primary Procedure Code and Potential Loss of Hospital Revenue
4.14.4Association between Coding Errors of Secondary Procedure Code and Potential Loss of Hospital Revenue
4.14.5Association between Coding Error Cases with Errors of Severity Level and Potential Loss of Hospital Revenue
4.14.6Association between Coding Error Cases with Errors of Case-Type and Potential Loss of Hospital Revenue
4.14.7Association between Cases with Incomplete Admission Form Potential Loss of Hospital Revenue
4.14.8Association between Cases with Discharge Summary and Potential Loss of Hospital Revenue
4.15Multiple Logistic Regression on Factors Influencing Accuracy of Assignment of Potential Hospital Tariff
Chapter 5Discussion
5.1Introduction
5.2Evaluation of Quality of Clinical Coding In UKMMC
5.2.1Quality of the Discharge Summary
5.2.2Coders’ Knowledge on Coding Process
5.2.3Implications of Doctors’ Demographic towards Clinical Coding
5.2.4Evaluation Method
5.3Issue of Under-Coding
5.3.1Poor Enforcement of Casemix System
5.3.2Unclear Rules and Guidelines
5.3.3Structural Limitations of Discharge Summary
5.3.4Ambiguities in Interpretation
5.4Economic Implication
5.4.1Ungroupable Case
5.4.2Importance of Birthweight
5.5Study Limitations
Chapter 6Conclusions and Recommendations
6.1Introduction
6.2Conclusions of Study’s Findings
6.3Recommendations
6.3.1Hospital Managers
6.3.2Coders
6.3.3Doctors
6.3.4Primary Reference of Clinical Coding
References
List of Appendices
Appendix AStudy Tools
Appendix BList of Top 50 Assigned Primary Diagnosis Code
Appendix CList of Top 50 Assigned Secondary Diagnosis Code
Appendix DList of Top 50 Assigned Primary Procedure Code
Appendix EList of Top 50 Assigned Secondary Procedure Code
Appendix FList of Top 50 Cases with Highest Potential Loss of Revenue
List of Figures
Figure 1.1 Flow of Casemix System
Figure 1.2 Conceptual Framework
Figure 2.1 Example of MY-DRG Code
Figure 3.1 Flow of the Study
Figure 4.1 Distributions of Coded Case by Case-Type
Figure 4.2 Distributions of Coded Cases by Age
Figure 4.3 Distributions of Coded Cases by Severity Level
List of Tables
Table 2.1 Definition of Components in Calculation of Hospital Tariff
Table 2.2 Percentage of Coding Errors in Previous Studies
Table 2.3 Type of Clinical Coding Errors
Table 2.4 Profit Loss due to Clinical Coding Errors
Table 3.1 UKMMC’s Patient Data from 2002 to 2013
Table 4.1 Distribution of Coding Errors Rate
Table 4.2 Type of Coding Errors Among Primary Diagnosis Code
Table 4.3 Example of Error Cases Among Primary Diagnosis Code
Table 4.4 Top 10 Primary Diagnosis Codes Assigned Before and After the Re-Coding Process
Table 4.5 Changes in the Assignment of Top 10 Primary Diagnosis Code Before the Re-Coding Process due to Coding Errors
Table 4.6 Distributions of the Number of Secondary Diagnosis Codes Assigned Before and After the Re-Coding Process
Table 4.7 Number of Secondary Diagnosis Codes Assigned Per Patient Before and After the Re-Coding Process
Table 4.8 Distributions of Error Cases by Number of Secondary Diagnosis Code
Table 4.9 Type of Coding Errors of Secondary Diagnosis Code
Table 4.10 Examples of Coding Errors Cases of Secondary Diagnosis Code
Table 4.11 Distributions of Top 10 Secondary Diagnosis Codes Assigned Before and After the Re-Coding Process
Table 4.12 Distributions of the Type of Coding Errors within Primary Procedure Codes
Table 4 .1 3 Examples of Error Cases in the Assignment of Primary Procedure Codes
Table 4.14 Top 10 Code Assigned as Primary Procedure Code Before and After the Re-Coding Process
Table 4.15 Changes in Top 10 Code Assigned as Primary Procedure Code Due to Coding Error
Table 4.16 Distributions of Total Number of Secondary Procedure Code Assigned to Patient Before and After the Re-Coding Process
Table 4.17 Distributions of Coding Error Cases by Number of Secondary Procedure Code
Table 4.18 Comparisons of Number of Secondary Procedure Code Assigned per Patient Before and After the Re-Coding Process
Table 4.19 Distributions of Type of Coding Errors in Secondary Procedure Code
Table 4.20 Example of Error Cases in the Assignment of Secondary Procedure Code
Table 4.21 Top 10 Code Assigned as Secondary Procedure Code Before and After the Re-Coding Process
Table 4.22 Distributions of Coding Errors by MY-DR G ® Case-Type
Table 4.23