Exploration of ICD-9-CM coding of chronic disease within the Elixhauser Comorbidity Measure in patients with chronic heart failure.

Q3 Medicine
Jennifer Hornung Garvin, Andrew Redd, Dan Bolton, Pauline Graham, Dominic Roche, Peter Groeneveld, Molly Leecaster, Shuying Shen, Mark G Weiner
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引用次数: 0

Abstract

Introduction: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes capture comorbidities that can be used to risk adjust nonrandom patient groups. We explored the accuracy of capturing comorbidities associated with one risk adjustment method, the Elixhauser Comorbidity Measure (ECM), in patients with chronic heart failure (CHF) at one Veterans Affairs (VA) medical center. We explored potential reasons for the differences found between the original codes assigned and conditions found through retrospective review.

Methods: This descriptive, retrospective study used a cohort of patients discharged with a principal diagnosis coded as CHF from one VA medical center in 2003. One admission per patient was used in the study; with multiple admissions, only the first admission was analyzed. We compared the assignment of original codes assigned to conditions found in a retrospective, manual review of the medical record conducted by an investigator with coding expertise as well as by physicians. Members of the team experienced with assigning ICD-9-CM codes and VA coding processes developed themes related to systemic reasons why chronic conditions were not coded in VA records using applied thematic techniques.

Results: In the 181-patient cohort, 388 comorbid conditions were identified; 305 of these were chronic conditions, originally coded at the time of discharge with an average of 1.7 comorbidities related to the ECM per patient. The review by an investigator with coding expertise revealed a total of 937 comorbidities resulting in 618 chronic comorbid conditions with an average of 3.4 per patient; physician review found 872 total comorbidities with 562 chronic conditions (average 3.1 per patient). The agreement between the original and the retrospective coding review was 88 percent. The kappa statistic for the original and the retrospective coding review was 0.375 with a 95 percent confidence interval (CI) of 0.352 to 0.398. The kappa statistic for the retrospective coding review and physician review was 0.849 (CI, 0.823-0.875). The kappa statistic for the original coding and the physician review was 0.340 (CI, 0.316-0.364). Several systemic factors were identified, including familiarity with inpatient VA and non-VA guidelines, the quality of documentation, and operational requirements to complete the coding process within short time frames and to identify the reasons for movement within a given facility.

Conclusion: Comorbidities within the ECM representing chronic conditions were significantly underrepresented in the original code assignment. Contributing factors potentially include prioritization of codes related to acute conditions over chronic conditions; coders' professional training, educational level, and experience; and the limited number of codes allowed in initial coding software. This study highlights the need to evaluate systemic causes of underrepresentation of chronic conditions to improve the accuracy of risk adjustment used for health services research, resource allocation, and performance measurement.

Abstract Image

Elixhauser合并症测量中慢性心力衰竭患者慢性疾病ICD-9-CM编码的探讨
简介:国际疾病分类,第九版,临床修改(ICD-9-CM)代码捕获合并症,可用于风险调整非随机患者群体。我们探讨了在退伍军人事务(VA)医疗中心的慢性心力衰竭(CHF)患者中,用一种风险调整方法Elixhauser共病测量(ECM)捕捉共病的准确性。我们探讨了通过回顾性审查发现的原始代码和条件之间存在差异的潜在原因。方法:这项描述性、回顾性研究纳入了2003年退伍军人医疗中心以主要诊断编码为CHF出院的患者。研究中使用了每位患者一次入院;对于多次录取,只分析第一次录取。我们比较了分配给由具有编码专业知识的调查员和医生进行的医疗记录回顾性手动审查中发现的条件的原始代码的分配。具有分配ICD-9-CM代码和VA编码过程经验的团队成员开发了与慢性病未在VA记录中使用应用主题技术进行编码的系统性原因相关的主题。结果:在181例患者队列中,确定了388例合并症;其中305例为慢性疾病,最初在出院时编码,平均每位患者有1.7例与ECM相关的合并症。由具有编码专业知识的研究者进行的审查显示,共有937种合并症导致618种慢性合并症,平均每位患者3.4种;医师审查发现共872例合并症,562例慢性疾病(平均每位患者3.1例)。原始代码和回顾性代码审查之间的一致性为88%。原始和回顾性编码审查的kappa统计量为0.375,95%置信区间(CI)为0.352至0.398。回顾性编码评价和医师评价的kappa统计量为0.849 (CI, 0.823-0.875)。原始编码和医师评价的kappa统计量为0.340 (CI, 0.316-0.364)。确定了几个系统因素,包括对住院VA和非VA指南的熟悉程度,文件的质量,以及在短时间内完成编码过程的操作要求,并确定在给定设施内移动的原因。结论:ECM内代表慢性疾病的合并症在原始代码分配中明显不足。可能的促成因素包括:将与急性疾病相关的代码置于慢性病之前;程序员的专业培训、教育水平和经验;以及初始编码软件中允许的有限数量的代码。本研究强调有必要评估慢性病代表性不足的系统性原因,以提高用于卫生服务研究、资源分配和绩效衡量的风险调整的准确性。
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来源期刊
CiteScore
1.90
自引率
0.00%
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期刊介绍: Perspectives in Health Information Management is a scholarly, peer-reviewed research journal whose mission is to advance health information management practice and to encourage interdisciplinary collaboration between HIM professionals and others in disciplines supporting the advancement of the management of health information. The primary focus is to promote the linkage of practice, education, and research and to provide contributions to the understanding or improvement of health information management processes and outcomes.
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