Related Experiment Videos
[Expenditure and reliability of ICD/ICPM-coding in routine surgery]
1Klinik für Allgemeinchirurgie, Philipps-Universität Marburg. stinner@mailer.uni-marburg.de
Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany))
|May 5, 1999
Summary
German hospitals implemented ICD-9 and OPS-301 coding for Diagnosis Related Groups (DRG) reimbursement. Physician-led coding controls are crucial to minimize financial risks from misclassifications.
Area of Science:
- Health Economics
- Medical Information Systems
- Hospital Administration
Context:
- German hospitals faced new legal requirements for reimbursement starting January 1996.
- Mandatory classification of cases using ICD-9 and the adapted ICPM code (OPS-301) for Diagnosis Related Groups (DRG) calculation.
- The study period covered January 1, 1996, to December 31, 1996, in a general surgery department.
Purpose:
- To evaluate the accuracy and impact of manual ICD-9 and ICPM (OPS-301) coding for hospital reimbursement.
- To identify misclassifications relevant for funding and assess the learning curve associated with the new coding system.
- To determine the coding spectrum required to cover the majority of cases in general surgery.
Summary:
- Manual coding resulted in 4.6% irrelevant and 7.2% funding-relevant misclassifications, with improvement noted over six months.
- A significant portion of general surgery cases (80-85%) were covered by approximately 200 diagnostic and therapeutic codes.
- The study highlights the challenges of non-computer-assisted coding processes in a complex hospital environment.
Impact:
- Confirms the necessity of a physician-based control system for diagnostic and therapeutic coding.
- Emphasizes the potential for minimizing economic risks associated with inaccurate hospital case classification.
- Provides insights into the efficiency and accuracy of coding systems for DRG-based reimbursement.