Table 3 Examples of changes in Hospital Coding Practice with regard to intention to improve data quality
From: A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme
Data Qulity Improvement | Structure | Process |
|---|---|---|
General | • Policy to improve quality of medical record • Form medical record audit committee • Incentive/punishment mechanisms to ensure timeliness of discharge summary completion by physician • Appoint a nurse as part-time coder • Appoint a physician to approve all discharge summary before coding • Recruit more medical statisticians • Clear career pathway for medical statisticians • Support medical statisticians to get certified as coders • Strengthen specialty-based skills of coders • Appoint a senior physician to supervise the whole coding process • Computerize medical record system | • Feedback mechanism • Revise workflow to improve medical record turnover • Weekly meeting on coding issues • Allow only physician to do the discharge summary • Physicians have to do coding themselves • Coder gives code based on discharge summary alone • Randomly select cases to check assigned code • Medical record audit results are publicly announced |
Differential | • Form summary and coding audit committee • Have a policy to ensure physician knowledge about DRG-based reimbursement • Appoint a senior management staff to be responsible for coding practice • Have separate staff responsible for each health insurance scheme • Incentive for good discharge summarizer & coder • Contract out or use coders from outside • Appoint a staff to be responsible for DRG grouper software • Keep inpatient and outpatient records separately • Supporting tools such as cheat sheet for common codes are prepared for coder | • Check health insurance status before coding • Records of patients with different health insurance undergo different coding system • Check only codes of UC patients • Staff other than responsible physician can add/edit information in the discharge summary • Coder can offer more codes than information in discharge summary • Coder can give code if there is enough evidence in the medical record • Coder can offer codes based on laboratory results alone • Coder can add or change what the physicians wrote in the discharge summary to match anticipated cost of care • Coder can ask the responsible physician to revise diagnosis and procedure information in the discharge summary to match the code already given • Purposively select cases to check assigned code • Self-develop software to check assigned codes • DRG software is used only for UC patients • Try all possible combination of codes to find the maximum possible RW • Try to swap the principal diagnosis with the secondary diagnosis to increase RW |