Psychiatric diagnoses as reported to Medicaid and as recorded in patient charts

This study was undertaken to address the issue of data reporting in the psychiatric sector of New York City Medicaid, the largest publicly financed psychiatric health care delivery system in the nation. Six outpatient psychiatric clinics in general hospitals, four with residency programs, and all 29 free standing psychiatric clinics in New York City were audited as were charts from 120 psychiatrists billing for 10 or more Medicaid patients. Overall agreement of chart and Medicaid diagnoses was 91% for psychiatrists, 79% for free-standing clinics, and 77% for hospital clinics. Agreement varied by diagnosis. Bias in the Medicaid diagnosis of Neurosis was found at the four hospitals having residency programs. Patients most likely to be misreported as having minimizing diagnoses were male, or between the ages of 18 and 29 years, or to have a prior history of psychiatric treatment. The errors in reporting in each provider sector would pose a methodological obstacle if Medicaid data were used in epidemiological research.