Research

Are central hospitals ready for National Health Insurance? ICD coding quality from an electronic patient discharge record for clinicians

Robin Edgar Dyers, Juliet Evans, Grant Alex Ward, Shane du Plooy, Hassan Mahomed

Abstract


Background. South Africa (SA)’s planned National Health Insurance reforms require the use of International Statistical Classification of Diseases (ICD) codes for hospitals to purchase services from the proposed National Health Authority. However, compliance with coding at public hospitals in the Western Cape Province has been challenging. A computer application was developed to aid clinicians in integrating ICD coding into the patient hospital discharge process.Objective. To evaluate the quality of ICD codes captured using the application and predictors thereof in a single hospital department.Methods. After 6 months, the quality of ICD codes was determined by comparing ICD code descriptors with medical concepts in a random sample of original patient records selected over a 6-week period. Patient and personnel characteristics influencing quality of coding, derived from a theoretical framework, were collected.Results. Of 223 patient records, 45.3% (95% confidence interval (CI) 38.8 - 51.9) had complete ICD codes. Primary ICD code accuracy was 74.0% (95% CI 67.8 - 79.5). Patient characteristics such as female gender, younger age group and fewer comorbidities, as well as seniority of clinician rank, were significantly associated with ICD coding being complete on adjusted analysis.Conclusion. The results of this study describe ICD coding quality at a central hospital in SA supported by a computer application and the factors influencing this. More interventions are required to achieve reliable coding data, such as additional ICD coding validation tools, training and oversight of junior clinicians.

Authors' affiliations

Robin Edgar Dyers, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa; Western Cape Government Department of Health, Cape Town, South Africa

Juliet Evans, Western Cape Government Department of Health, Cape Town, South Africa

Grant Alex Ward, Western Cape Government Department of Health, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Shane du Plooy, Western Cape Government Department of Health, Cape Town, South Africa

Hassan Mahomed, Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa; Western Cape Government Department of Health, Cape Town, South Africa

Full Text

PDF (93KB)

Keywords

ICD coding; National Health Insurance; NHI; Discharge summary; Discharge process; Inpatient; Electronic discharge record

Cite this article

South African Medical Journal 2016;106(2):181-185. DOI:10.7196/SAMJ.2016.v106i2.10079

Article History

Date submitted: 2015-09-23
Date published: 2016-01-08

Article Views

Abstract views: 2263
Full text views: 735

Comments on this article

*Read our policy for posting comments here