Assessment of E-coding practices and costs in Massachusetts hospitals

Hospital discharge data are a potentially useful information resource for documenting the epidemiology of nonfatal injuries. However, hospitals often do not include E-codes that identify external causes of injury in discharge abstracts. One barrier has been assumed to be the cost of assigning E-codes to medical records. Directors of medical records at hospitals in Massachusetts were surveyed to assess the validity of a cost-assessment study by Rivara and coworkers and to determine what resources they would need to E-code all injury discharges. According to Rivara's estimates, injury coding an additional 500 hospital discharges would entail a continuing cost to each hospital of about $600 a year. More than half of the survey's 101 respondents believed that the estimates were accurate, 16 percent believed that the estimates were inaccurate, and 27 percent were unable to assess the potential costs. Among the resources needed to E-code all injury-related discharges, respondents most often cited training for those who assign the codes and the approval of the hospital administration. Only 20 percent of the respondents cited needs directly related to ongoing costs. The perception by hospitals of the cost of E-coding, frequently cited as a major barrier to the use of hospital discharge data as an injury surveillance source, did not emerge in this survey as an overriding concern.