Friday August 1, 2008
ICU billing code inconsistency

See this very interesting study titled "Reliability of diagnostic coding in intensive care patients". Is this inconsistency because patients are too sick or we don't know, how to bill?

Introduction: Administrative coding of medical diagnoses in intensive care unit (ICU) patients is mandatory in order to create databases for use in epidemiological and economic studies. We assessed the reliability of coding between different ICU physicians.

Methods: One-hundred medical records selected randomly from 29,393 cases collected between 1998 and 2004 in the French multicenter Outcomerea ICU database were studied. Each record was sent to two senior physicians from independent ICUs who re-coded the diagnoses using the International Classification of Diseases - 10th revision (ICD-10) after being trained according to guidelines developed by two French national intensive care medicine societies, the French Society of Intensive Care Medicine (SRLF) and French Society of Anesthesiology and Intensive Care Medicine (SFAR). These codes were then compared to the original codes, which had been selected by the physician treating the patient. A specific comparison was done for the diagnoses of septicemia and shock.

Results: The ICU physicians coded an average of 4.6+/-3.0 (range 132) diagnoses per patient, with little agreement between the three coders.

• The primary diagnosis was matched by both external coders in 34% of cases, by only one in 35%, and by neither in 31%.
• Only 18% of all codes were selected by all three coders.
• Similar results were obtained for the diagnoses of septicemia and/or shock.

Conclusions: In a multicenter database designed primarily for epidemiological and cohort studies in ICU patients, the coding of medical diagnoses varied between different observers. This could limit the interpretation and validity of research and epidemiological programs using diagnoses as inclusion criteria.


References: Click to get abstract/article

1. Reliability of diagnostic coding in intensive care patients Critical Care 2008, 12:R95