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| Diagnosis and operation filling and coding defect of the first page of high rate paying cases based on DRGs payment |
| Liang Jingxing1, Zhao Yuebao1, Huang Yong2, Wu Yuewen1, Huang Xiaolin1, Lun Yanhong3, Ye Mingkun1, Yang Hongjuan1, Wu Xiaomin1, Xie Liling1, Zhou Tingting1 |
1.Department of Medical Records and Statistics, Guangdong General Hospital's Nanhai Hospital (Second People's Hospital of Nanhai District of Foshan), Foshan 528251, China;
2.Orthopedics and Traumatology Department of Traditional Chinese Medicine, Guangdong General Hospital's Nanhai Hospital (Second People's Hospital of Nanhai District of Foshan);
3.Medical Section, Guangdong General Hospital's Nanhai Hospital (Second People's Hospital of Nanhai District of Foshan) |
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Abstract Objective To analyze the defective problems existing in the data filling in the front page of medical records of the high rate cases whose cost were more than twice the average cost based on DRGs payment in a hospital, and to put forward improvement measures.Methods The hospital received the high rate cases which were grouped by DRGs and settled expenses between January, 2018 and June, 2018 from the Social Security Bureau's feedback. Combined with DRGs payment mode, under the guidance of the diagnosis operation selection standard announced by the Health Development Planning Commission and the Principles of International Classification of Diseases, selfcheck and retrospective analysis were conducted, and the defects were classified and counted with 6 cases of high rate paying.Results Totally 111 of 526 high rate cases had defect problems related to clinicians and coders, with defective rate 21.11%, and among them, 47, 20, 12 and 29 cases were clinicians' main diagnostic error selection, main operation error selection , main diagnosis and operation error selection, and missing of diagnosis or operation, respectively. The percentage of errors was 42.34%, 18.02%, 10.81% and 26.13% respectively. The coders' main diagnosis coding error and main surgical coding error were 2 and 1 cases respectively, with error rate 1.8% and 0.9% respectively.Conclusion The high rate paying cases caused by the defects of the filling diagnosis and operation and the coding defects on the front page of medical records were closely related to the quality of filling by clinicians and the coding level of coders. Effective measures are to train clinicians to correctly select diagnosis and operation, improve coders' professional skills, and optimize coders' work, so as to reduce high rate cases caused by defective problems.
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