使用共发病性检测算法软件进行回顾性分析,以确定国际疾病分类 (ICD) 代码遗漏的发生率和诊断相关组 (DRG) 代码修改器的适当性
Eilon Gabel1, Jonathan Gal2, Tristan Grogan3
1University of California at Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA. egabel@mednet.ucla.edu.
BMC medical informatics and decision making
|October 24, 2024
概括
自动化算法在国际疾病分类 (ICD) 编码中发现了重大遗漏,导致了不准确的诊断相关组 (DRG) 分配和大量收入损失. 通过技术提高ICD代码的准确性可以提高财务结果.
科学领域:
- 医疗信息学 医疗信息学
- 医疗编码系统 医学编码系统
- 医疗保健 财务管理 财务管理
背景情况:
- 经过认证的编码人员对国际疾病分类 (ICD) 和诊断相关组 (DRG) 代码进行手动审查是标准做法.
- 高敏度ICD代码对于证明DRG修改器的合理性和指示所需的医院资源至关重要.
- 之前对审计行政法规的基于规则的算法进行的评估显示,在财务或人口影响方面没有显著差异.
研究的目的:
- 评估基于规则的计算机算法的有效性,以识别遗漏的ICD代码.
- 量化ICD代码遗漏的下游财务和人口影响.
- 评估增强智能在提高行政数据准确性方面的潜力.
主要方法:
- 利用了来自加州大学洛杉矶分校麻醉学和外科手术医学的外科手术数据仓库 (EPIC EHR) 的数据.
- 开发并运行了18种疾病状态的算法,与2019年的34,104例住院病例相比.
- 分析了ICD代码的遗漏,DRG修改器的适当性,按付款人阶级的潜在财务影响,以及按种族,性别,年龄和财务阶级的错误编码.
主要成果:
- 32.9%的入院患者有没有相应的ICD代码的疾病状态.
- 5.8%的招生有资格进行DRG修改,估计收入损失超过2260万美元.
- 显著的p值 (<0.05) 表示与参考群体相比,ICD遗漏率在支付人阶级,种族,性别和年龄组之间存在差异.
结论:
- 基于规则的算法有效地使用结构化EHR数据在住院病人的索赔中识别了遗漏的ICD代码.
- 缺少ICD代码导致DRG修改器不准确,并导致显著的补偿不足.
- 将增强智能集成到编码工作流中可以提高行政数据的准确性和财务绩效.
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