Quality of Coding for Trauma Using ICD10

Abstract

Background: The quality of coding for diagnoses and external causes of trauma to a great extend contributes to trauma classification, monitoring, and prevention. Objectives: The present study aimed to assess the trauma coding quality using ICD10. Methods: In this descriptive applied study, 591 records of trauma patients in educational hospitals affiliated to the Shahid Beheshti University of Medical Sciences (SBUM) were selected to assess coding quality based on ICD10 in 2018. Data were collected using a checklist and analyzed using IBM SPSS Statistics 20.0. Results: The mean accuracy, completeness, and quality of trauma coding were 64.5%, 70%, and 67.5%, respectively. Conclusion: High-quality coding of trauma diagnosis creates a more reliable databank which can be used for planning and policy-making aiming to prevent and reduce traumatic events. The accuracy and completeness of medical diagnoses should be regularly and periodically reviewed to ensure the quality of the codes.