|
KMID : 0366519960160010121
|
|
Annual Bulletin Seoul Health
1996 Volume.16 No. 1 p.121 ~ p.136
|
|
|
A Comparision Study of Diagnosis Code in Both Medical Records and Medical Claim Bills for Same Discharge Patient -Focused on the Inpatient 10 Frequent Diseases-
|
|
Shin Jong-Yeun
|
|
|
Abstract
|
|
|
|
This study was carried out to compare the diagnostic codes of patients’ medical records with those of medical claim bills. For this study, diagnostic codes(ICD-9) were selected from the inpatient frequent 10 diseases in Medical Insurance Statistical Yearbook. Samples were derived from 2 general hospitals(A, B) which have 800 beds in Seoul but they have different coding process for submitting medical claim bills. Diagnostic codes in medical records and medical claim bills of 1,370 patients discharged with frequent 10 diseases from above hospitals were used for this analysis. The followings are the results of this comparision. 1. The numbers of diagnostic codes. . It was found that the over-coding rates in medical claim billing data were 56.1% out of 1,370 cases. . Hospital A has higher adding rate(166%) codes than hospital B(97%) in medical claim billing data. This was statistically significant(p<0.01). . Among the frequent 10 diseases, the highest adding rate diagnostic codes(166%) were found in NSVD(650). 2. Degree of agreement in ICD-9 codes. . Only 268(19.6%) out of 1,370 cases agreed with 4-digit code of all diagnosis in both medical records & medical claim bills. This was not statistically significant in both hospital A and B(p>0.01). . Among 3,472 codes written in 1,370 medical records, 2355(67.8%) were agreed with 3-dig it code and 1978(57.0%) were agreed with 4-digit code. Agreement rate of hospital A was higher than that of hospital B and this was statistically significant (p<0.01). ? 152(11.1%) out of 1,370 case in the frequent 10 diagnosis were not agreed with 3-digit code. The highest agreement rate were found in 774(other perinatal jaundice), and 366 (cataract), and the lowest agreement rate were found in 009(ill-defined intestinal infection), and 486(peneumonia, organism unspecified). ? The largest number of diagnosis in chapter 9(disease of the digestive system) and chapter 16 (symptoms, signs and ill -defined conditions) were added to medical claim bills. 3. Degree of agreement in principle diagnosis codes. . The 81.8% of principle diagnosis codes agreed with 3-digit and 67.5% with 4-digit. ? Hospital A had higher agreement than hospital B but this was not statistically significant(p>0.01). ? Among the principle diagnosis codes, 366 and 774 showed the highest agreement and 009 and 486 showed the lowest agreement with the principle diagnosis codes in medical claimbills. As the result of the study, diagnosis coding process system in hospital A was confirmed to have higher adding rate and to have higher agreement rate, but the sequence of principle diagnosis was not taken into consideration in hospital A For the effective use of hospital information, the effort for agreement of principle diagnosis must be achieved in both medical records and medical claim bills.
|
|
|
KEYWORD
|
|
|
diagnostic code, agreement, principle diagnosis
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|