Diagnosis and operation filling and coding defect of the first page of high rate paying cases based on DRGs payment

Liang Jingxing; Zhao Yuebao; Huang Yong; Wu Yuewen; Huang Xiaolin; Lun Yanhong; Ye Mingkun; Yang Hongjuan; Wu Xiaomin; Xie Liling; Zhou Tingting

doi:10.3969/j.issn.1006-5253.2019.04.021

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Chinese Journal of Hospital Statistics ›› 2019, Vol. 26 ›› Issue (4) : 307-310. DOI: 10.3969/j.issn.1006-5253.2019.04.021

Diagnosis and operation filling and coding defect of the first page of high rate paying cases based on DRGs payment

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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, selfcheck 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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DRGs / high rate / defect / diagnosis and surgical operation / code

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Liang Jingxing, Zhao Yuebao, Huang Yong, et al. Diagnosis and operation filling and coding defect of the first page of high rate paying cases based on DRGs payment[J]. Chinese Journal of Hospital Statistics, 2019, 26(4): 307-310 https://doi.org/10.3969/j.issn.1006-5253.2019.04.021