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Is sepsis accurately coded on hospital bills?
Daniel A Ollendorf1, A Mark Fendrick, Karen Massey
1Policy Analysis Inc., Brookline, Massachusetts 02445, USA.
Summary
Hospital billing codes for severe sepsis are only moderately accurate, with many cases missed. Relying solely on these codes for sepsis surveillance or research may lead to significant errors.
Area of Science:
- Medical Informatics
- Healthcare Administration
- Clinical Research
Background:
- Accurate coding of severe sepsis on hospital bills is crucial for surveillance and research.
- Previous studies have not fully assessed the sensitivity of administrative data for sepsis identification.
Purpose of the Study:
- To evaluate the accuracy of sepsis coding on hospital bills.
- To determine the reliability of ICD-9-CM codes for identifying severe sepsis cases.
Main Methods:
- Retrospective review of 122 hospital inpatient uniform bills (UB-92) for patients with severe sepsis.
- Analysis of ICD-9-CM diagnosis codes present on final hospital bills.
- Comparison of coded diagnoses with clinical documentation of severe sepsis.
Main Results:
- 75.4% of hospital bills contained codes for septicemia and/or bacteremia.
- 12.3% of bills had codes for major systemic infection and organ failure but not sepsis.
- 12.3% of bills lacked any sepsis-indicative diagnoses.
Conclusions:
- ICD-9-CM codes on hospital bills show only moderate sensitivity for identifying patients with severe sepsis.
- Exclusive reliance on administrative data for sepsis surveillance or research planning may introduce substantial inaccuracies.