Related Experiment Video
Updated: Jun 25, 2026
06:55
Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Screening algorithms to assess the accuracy of present-on-admission coding
Michael Pine1, Donald E Fry, Barbara Jones
1Department of Medicine, University of Chicago, USA.
Perspectives in Health Information Management
|February 24, 2009
Summary
Accurate coding of present-on-admission modifiers is crucial for reliable healthcare analytics and reimbursement. This study developed screens to identify coding inaccuracies, revealing significant quality issues across hospitals.
Area of Science:
- Health Informatics
- Medical Coding Quality Assurance
- Healthcare Data Analytics
Background:
- Present-on-admission (POA) modifiers are essential for accurate ICD-9-CM diagnosis coding.
- Inconsistent POA modifier coding can negatively impact risk-adjusted outcome analyses and hospital reimbursement.
- Standardized coding requirements necessitate robust quality control measures for POA designations.
Purpose of the Study:
- To develop and evaluate a set of screens for assessing the plausibility of present-on-admission designations.
- To identify and quantify coding inaccuracies in POA modifiers using real-world claims data.
- To provide a cost-effective method for quality control of enhanced claims data.
Main Methods:
- Development of 12 screens to evaluate the plausibility of POA designations.
- Testing of these screens using New York State claims data from 2003-2005.
- Analysis of hospital coding performance based on composite scores derived from screen application.
Main Results:
- The developed screens identified numerous potential coding problems in POA designations.
- 39% of hospitals achieved a composite score above 90%, indicating high coding quality.
- 36% of hospitals scored 80% or less, highlighting significant areas for improvement in POA coding.
Conclusions:
- The developed screening approach is effective in identifying POA coding quality issues.
- Adoption of these or similar screens can enhance the integrity of clinical performance reports.
- This analytic method offers a cost-effective solution for data quality control in healthcare claims.
Related Concept Videos
01:10Documentation of Nursing Diagnosis
The nurse documents nursing diagnoses and enters them into the patient record. The identified patient's nursing diagnosis is either written out with a plan of care or entered into the electronic health record.
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters assessment...
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters assessment...
01:15Receiver Operating Characteristic Plot
A ROC (Receiver Operating Characteristic) plot is a graphical tool used to assess the performance of a binary classification model by illustrating the trade-off between sensitivity (true positive rate) and specificity (false positive rate). By plotting sensitivity against 1 - specificity across various threshold settings, the ROC curve shows how well the model distinguishes between classes, with a curve closer to the top-left corner indicating a more accurate model. The area under the ROC curve...
01:22Nursing Diagnosis
Following assessment, a nursing diagnosis is the next step in the nursing process. It begins after the nurse has collected and recorded the patient data. The purpose of diagnosing is to identify how the client responds to actual or potential health processes, identify factors that bestow or that cause health problems, the etiologies, and identify resources or strengths the individual, group, or community can draw on to prevent or resolve problems.
The nursing diagnosis focuses on evidence-based...
The nursing diagnosis focuses on evidence-based...