Chen Chien P, Braunstein Steve, Mourad Michelle, Hsu I-Chow J, Haas-Kogan Daphne, Roach Mack, Fogh Shannon E
Department of Radiation Oncology, Scripps Clinic, San Diego, California.
Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
Pract Radiat Oncol. 2015 Jan-Feb;5(1):e45-51. doi: 10.1016/j.prro.2014.03.007. Epub 2014 May 22.
Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding.
We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers.
Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention).
Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming.
准确的国际疾病分类（ICD）诊断编码对于患者护理、计费以及研究工作至关重要。在这项单机构研究中，我们评估了我们的基线ICD - 9（第9版）诊断编码准确性，确定了导致编码不准确的最常见错误，并实施了多模式策略以改善放射肿瘤学编码。
我们前瞻性地研究了我们放射治疗特定电子病历系统中的ICD - 9编码准确性。基线ICD - 9编码准确性通过对2010年3月至6月在我们机构接受治疗的所有患者的ICD - 9编码准确性进行图表审查获得。为了提高性能，举办了一次教育会议，突出常见编码错误，并实施了一个用户友好的软件工具RadOnc ICD Search 1.0版，用于对放射肿瘤学特定诊断进行编码。然后我们前瞻性地分析了2010年7月至2011年6月期间所有接受治疗患者的ICD - 9编码准确性，目标是保持80%或更高的编码准确性。每月对编码准确性数据进行分析并反馈给各个提供者。
医生的基线编码准确性为661例中的463例（70%）。只有46%的医生编码准确性高于80%。最常见的错误涉及转移病例，其中原发或继发部位的ICD - 9编码要么不正确要么缺失，以及特殊程序如立体定向放射外科病例。实施我们的项目后，总体编码准确性提高到92%（范围为86% - 96%）。所有医生的中位准确性为93%（范围为77% - 100%），只有1名主治医生的准确性低于80%。转移病例中不正确的原发和继发ICD - 9编码显示出最显著的改善（干预后从10%降至2%）。
识别常见编码错误并实施教育和系统变革导致编码准确性显著提高。这个质量保证项目突出了医生ICD - 9编码准确性的潜在问题，并提供了一种有效解决这一缺陷的方法。
