Evaluating the Accuracy and Causes of Discrepancies in Recording Disease Codes and Procedure Codes, A Case Study of a Community Hospital in Lopburi Province
Keywords:
disease coding, discrepancy, ICD, medical recordsAbstract
This study aimed to assess the accuracy of disease and procedure coding, analyze coding discrepancies, and identify their causes in a community hospital in Lopburi Province. A mixed-methods approach was employed using a convergent parallel design. Quantitative data were collected from 7,381 inpatient records discharged between October 1, 2022, and September 30, 2023. Qualitative data were gathered through interviews with 12 physicians and 3 medical coders. Descriptive statistics were used to analyze the quantitative data, while content analysis was applied to the qualitative responses.
Results show that a total of 7,197 records (97.5%) were accurately coded in accordance with ICD standards, while 184 records (2.5%) contained coding errors. Of these, 121 records (65.8%) involved inaccurate diagnosis summaries provided by physicians, and 63 records (34.2%) resulted from coding errors by coders. The primary causes of discrepancies included a lack of understanding of NHSO diagnostic criteria, incomplete medical documentation, and insufficient ICD knowledge among staff. These issues impacted reimbursement processes, statistical reporting, budget assessments, treatment planning, and the overall quality of medical records.
The findings underscore the need for ongoing ICD training, the development of joint documentation guidelines between physicians and coders, and the implementation of a pre-submission verification system to enhance coding accuracy and improve data quality.
Keywords: accuracy; discrepancy; ICD; medical records
References
Bureau of Policy and Strategy, O. o. t. P. S., Ministry of Public Health. (2012). Guidelines for Medical Record Documentation for Physicians. (1 ed.). Office of Printing Affairs, War Veterans Organization of Thailand.
Chanokporn Phumikaree, Rapot Promsatyaprot, & Phadoongsit Chamnarnborirak. (2020). Development of the Reimbursement Process for Public Health Services under the Diagnosis Related Groups (DRG) System at Prasrimahabhodi Hospital, Ubon Ratchathani Province. Community Public Health. https://he02.tci-thaijo.org/index.php/ajcph/article/view/247450
Farkhondeh Asadi, Ahmadi Hosseini Maryam, Gomar Tahereh, & Sabahi Azam. (2022). Factors Affecting Clinical Coding Errors. https://brieflands.com/articles/semj-122161
Hendra Rohman. (2022). Accuracy and Validity Outpatient Diagnosis Code Base On ICD-10 at Imogiri I Health Center Bantul Yogyakarta. Proceeding International Conference on Medical Record, 2, 26-31. https://doi.org/10.47387/icmr.v2i1.151
Jinghui, L., Daniel, C., Anthony, N., & Karin, V. (2021). Early prediction of diagnostic-related groups and estimation of hospital cost by processing clinical notes. NPJ Digital Medicine, 4.
Kamonwan Wongfung. (2022). A study on Summary of Discharge Diagnosis on Neurosurgery at Thammasat University Hospital. Thammasat University Hospital Journal Online, 7(2), 18-30. https://he02.tci-thaijo.org/index.php/TUHJ/article/view/258451
Kun, Z., Hong-Ying, L., Die, Z., & Zai-Jun, L. (2020). The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review. (1472-6963 (Electronic)).
Mehrdad, F., & Abbas, S. (2009). Evaluation of factors influencing accuracy of principal procedure coding based on ICD-9-CM: an Iranian study. (1559-4122 (Electronic)). https://pmc.ncbi.nlm.nih.gov/articles/PMC2682663/
National Health Security Office. (2002). History of the National Health Security Office and the National Health Security Act, B.E. . https://www.nhso.go.th/page/history
Organization), H. A. I. P. (2020). Manual for Quality Assessment of Medical Record Documentation, 2020 (1 ed.). Sahamit Printing and Publishing Co., Ltd.
Phenprapha Phornsrimet, K. S. (2017). Improvement of the Efficiency of Reimbursement in the Drug Related Groups’ System Journal of Health Science 25(5), 865-871. https://thaidj.org/index.php/JHS/article/view/371
Sompaen Srinukham, Waraporn Panngoen, Thani Raknam, & Yupaporn Wattanakun. (2017). A Study on the Coding of Diagnoses, Procedures, and Surgeries for Medical Expenses under the Diagnosis Related Groups (DRG) System at the Hospital for Tropical Diseases. Journal of Integrated Social Sciences, Mahidol University, 1(2), 125-143. https://so02.tci-thaijo.org/index.php/isshmu/article/view/145985
Wandee Wansrisuthon, Supachok Singhakan, & Sudsabai Chulakatappa. (2020). A Study on the Discrepancies in Diagnostic and Procedural Summarization Affecting ICD Coding from Real-Time ICD Audit of Inpatients at the Department of Psychiatry, Siriraj Hospital. Siriraj Medical Bulletin, 5(2), 62-68. https://he02.tci-thaijo.org/index.php/simedbull/article/view/242222
Wannaporn Sriuthai. (2022). Results of the Medical Record Coding Audit for Inpatient Reimbursement under the DRG System, 2022, NHSO Region 4 Saraburi [Meeting Documents](Presentation of the Report of the National Health Security Office, Saraburi, Issue.
Working Group on the Development of Joint Audit and Regulatory Mechanisms for Service
Reimbursement and Healthcare Quality among the Three Health Insurance Funds. (2020). Guidelines for the Audit of Supporting Documents for Public Health Service Reimbursement under the Collaboration of the Three Health Insurance Funds, 2020
Downloads
Published
How to Cite
Issue
Section
License
Disclaimer and Copyright Notice
The content and information presented in articles published in the Journal of Law and Public Health Policy represent the opinions and sole responsibility of the respective authors. The editorial board does not necessarily agree with or assume any responsibility for the views expressed.
All articles, data, content, images, and other materials published in the Journal of Law and Public Health Policy are the intellectual property of the journal. Any individual or organization wishing to reproduce, distribute, or otherwise use the entirety or any part of such materials must provide proper citation.
