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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