Hospital Coding of Postoperative Ileus: A Prospective Study

Background Postoperative ileus (POI) is among the most common complications affecting patients who undergo major abdominal surgery. Because of the high volume of major surgery and the high incidence of postoperative ileus, failure to code for this complication may have a significant impact on hospital reimbursement and quality measures. Objectives This paper investigates the magnitude of the difference between the prevalence of POI as coded in administrative data versus the prevalence based upon a prospectively applied operational definition of POI in patients undergoing intestinal resection surgery. Methods Data was collected during the course of a prospective study at the University of Iowa Hospitals & Clinics on an investigational digital health device for predicting operationally defined POI. Following the first 24 hours post-surgery, a patient was identified as experiencing POI as operationally defined by the occurrence of vomiting, reversal of diet and/or placement of a nasogastric tube. For all subjects, billing data was also collected. Results A total of 203 adult patients undergoing intestinal resection surgery consented to participate. Of patients who developed POI based on the operational definition, 35% were not coded accordingly to capture appropriate risk adjustment and reimbursement. Conclusions Patients who experienced indicators of POI but who were not coded experienced over two days of additional time in the hospital compared to patients who did not experience POI, representing significant unreimbursed costs. Timing and duration of POI indicators appear to impact coding discrepancies and may suggest means for improving caregiver identification of POI in a patient's medical record.