Hsia D C
Office of Inspector General, US Department of Health and Human Services, Washington, DC 20201.
JAMA. 1990 Jul 4;264(1):59-62.
Diagnosis related group (DRG) 129 consists exclusively of discharges having a principal diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification code 427.5 (cardiac arrest). It excludes patients with more specific diagnoses (eg, myocardial infarction and arrhythmia) or patients admitted for a different reason and who subsequently experience cardiac arrest. This study used a one-stage sample design to select all DRG 129 discharges from random hospitals, stratified by their annual number of DRG 129 bills. Using blinded techniques, medical records specialists reabstracted the International Classification of Diseases codes for 857 medical records. For the bills that were not coded DRG 129 on reabstraction, physicians classified the incorrect bills by clinical situation and reason for error. Diagnosis related group 129 had significantly higher rates of coding errors and upcoding than other DRGs. Of discharges erroneously billed to DRG 129, 42.1% of the patients entered the hospital for heart disease other than cardiac arrest and 55.2% died after entering the hospital for other diseases. Attending physicians need to distinguish between the "immediate cause" of death for the death certificate and the "principal diagnosis" for reimbursement purposes.
诊断相关分组（DRG）129仅包含主要诊断为《疾病和有关健康问题的国际统计分类》第九次修订本临床修订版代码427.5（心脏骤停）的出院病例。它排除了具有更具体诊断（如心肌梗死和心律失常）的患者，或因其他原因入院且随后发生心脏骤停的患者。本研究采用单阶段抽样设计，从随机选择的医院中选取所有DRG 129出院病例，并按其DRG 129账单的年度数量进行分层。医疗记录专家采用盲法技术，对857份医疗记录重新提取了《疾病和有关健康问题的国际统计分类》代码。对于重新提取时未编码为DRG 129的账单，医生根据临床情况和错误原因对错误账单进行了分类。诊断相关分组129的编码错误率和高编码率显著高于其他DRG。在错误计费为DRG 129的出院病例中，42.1%的患者因心脏骤停以外的心脏病入院，55.2%的患者因其他疾病入院后死亡。主治医生需要区分死亡证明上的“直接死因”和报销目的的“主要诊断”。
