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KMID : 0371020000330010076
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Journal of Preventive Medicine and Public Health
2000 Volume.33 No. 1 p.76 ~ p.82
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The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims
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Park Jong-Ku
Kim Ki-Soon
Kim Chun-Bae
Lee Tae-Yong
Lee Kang-Sook
Lee Duk-Hee
Lee Sun-Hee
Jee Sun-Ha
Suh Il
Koh Kwang-Wook
Ryu So-Yeon
Park Kee-Ho
Park Woon-Je
Wang Seung-Jun
Lee Hwa-Soon
Chae Yoo-Mi
Hong Hyun-Sook
Suh Jin-Sook
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Abstract
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Objectives : We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system.
Methods : A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or ´definite stroke´ in CT/MRI finding. We questioned the medical record administrators to explain the error if the diagnoses were not coded as stroke.
Results : The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not avaliable for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in ´major clinical symptoms´ or ´neurological deficits´. The most common reason was ´to meet review criteria of medical insurance benefits (52.9%)´. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital.
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KEYWORD
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Nationwide surveiliance system, Medical insurance claims, Accuracy, Cerebrovascular diseases
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