Does Improving Medical Record Documentation Better Reflect Severity of Illness in Neurosurgical Patients?

Spurgeon, Angela; Hiser, Bradley; Hafley, Carol; Litofsky, N. Scott

doi:10.1227/01.neu.0000386977.17441.98

Cited by 1 publication

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, episodes with higher SOI levels usually present multiple co-morbidities affecting different organ systems (Averill et al, 2013). Thus, accurate and complete coding of co-morbidities is particularly important in APR-DRG classification as the patient’s SOI has a significant role in hospital payment (Spurgeon et al, 2011). For instance, in Portugal, a hospital that treats a patient assigned to APR-DRG 1944, which represents heart failure patients (base APR-DRG 194) with an extreme SOI, will be paid with an amount about five, three and two times higher than cases assigned to the same base APR-DRG with SOI levels 1, 2 and 3, respectively (Administração Central do Sistema de Saúde, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Despite their clinical significance, evidence elsewhere has shown that certain co-morbidities are generally under-reported in administrative databases (Austin et al, 2005), while the prevalence of others is overestimated when compared with the information of medical charts (Blumenthal, 1996; Chong et al, 2011; Hawker et al, 1997; Humphries et al, 2000; Iezzoni et al, 1992; Kieszak et al, 1999; Malenka et al, 1994; McCarthy et al, 2000; Mears et al, 2002; Newschaffer et al, 1997; Normand et al, 1995; Powell et al, 2001; Preen et al, 2004; Romano et al, 1994; Sarfati et al, 2010; Spurgeon et al, 2011; Waite et al, 1994). Overall, asymptomatic conditions tend to be under-reported in administrative datasets (Powell et al, 2001; Romano et al, 1994), while certain acute medical conditions or complications tend to be regarded by medical coders as more important than others, thereby originating this coding bias (Iezzoni et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases

Souza

Santos

Bolón-Canedo

et al. 2019

HIM J

View full text Add to dashboard Cite

Background: The All Patient-Refined Diagnosis-Related Groups (APR-DRGs) system has adjusted the basic DRG structure by incorporating four severity of illness (SOI) levels, which are used for determining hospital payment. A comprehensive report of all relevant diagnoses, namely the patient’s underlying co-morbidities, is a key factor for ensuring that SOI determination will be adequate. Objective: In this study, we aimed to characterise the individual impact of co-morbidities on APR-DRG classification and hospital funding in the context of respiratory and cardiovascular diseases. Methods: Using 6 years of coded clinical data from a nationwide Portuguese inpatient database and support vector machine (SVM) models, we simulated and explored the APR-DRG classification to understand its response to individual removal of Charlson and Elixhauser co-morbidities. We also estimated the amount of hospital payments that could have been lost when co-morbidities are under-reported. Results: In our scenario, most Charlson and Elixhauser co-morbidities did considerably influence SOI determination but had little impact on base APR-DRG assignment. The degree of influence of each co-morbidity on SOI was, however, quite specific to the base APR-DRG. Under-coding of all studied co-morbidities led to losses in hospital payments. Furthermore, our results based on the SVM models were consistent with overall APR-DRG grouping logics. Conclusion and implications: Comprehensive reporting of pre-existing or newly acquired co-morbidities should be encouraged in hospitals as they have an important influence on SOI assignment and thus on hospital funding. Furthermore, we recommend that future guidelines to be used by medical coders should include specific rules concerning coding of co-morbidities.

show abstract

Section: Introductionmentioning

confidence: 99%