Hospital Coding of Postoperative Ileus: A Prospective Study

Area of Science:

• Gastroenterology
• Surgical Complications
• Health Informatics

Background:

• Postoperative ileus (POI) is a frequent complication following major abdominal surgery.
• Inaccurate coding of POI impacts hospital reimbursement and quality metrics.
• High incidence and volume of surgeries necessitate precise POI identification.

Purpose of the Study:

• To compare the coded prevalence of POI in administrative data against its actual prevalence using a prospective operational definition.
• To quantify the discrepancy in POI coding for patients undergoing intestinal resection.
• To assess the financial and quality measure implications of undercoded POI.

Main Methods:

• Prospective study at University of Iowa Hospitals & Clinics.
• Utilized an investigational digital health device for POI prediction.
• Operationally defined POI by vomiting, diet reversal, or nasogastric tube placement within 24 hours post-surgery.
• Collected and analyzed patient billing data.

Main Results:

• 203 adult patients undergoing intestinal resection surgery participated.
• 35% of patients who met the operational definition for POI were not coded as such.
• Undercoded POI patients experienced over two additional hospital days compared to those without POI.

Conclusions:

• Significant undercoding of POI exists in administrative data.
• This discrepancy leads to substantial unreimbursed costs and affects risk adjustment.
• Improving caregiver identification of POI indicators is crucial for accurate coding and reimbursement.