Incidence of clinical coding errors and implications on casemix reimbursement in a teaching hospital in Malaysia

Siti Athirah Zafirah binti Abdul Rashid, Amrizal Muhd Nur, Sharifa Ezat Wan Puteh, Syed Mohamed Al-Junid Syed Junid

Research output: Contribution to journalArticle

Abstract

Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital's income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient's medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O & G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.

Original languageEnglish
Pages (from-to)19-28
Number of pages10
JournalMalaysian Journal of Public Health Medicine
Volume17
Issue number2
Publication statusPublished - 2017

Fingerprint

Malaysia
Teaching Hospitals
Clinical Coding
Incidence
Budgets
Health Services
Medical Records
Databases
Pediatrics

Keywords

  • Casemix system
  • Clinical coding
  • Coding errors
  • Diagnosis
  • Procedures

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Incidence of clinical coding errors and implications on casemix reimbursement in a teaching hospital in Malaysia. / Rashid, Siti Athirah Zafirah binti Abdul; Nur, Amrizal Muhd; Wan Puteh, Sharifa Ezat; Syed Junid, Syed Mohamed Al-Junid.

In: Malaysian Journal of Public Health Medicine, Vol. 17, No. 2, 2017, p. 19-28.

Research output: Contribution to journalArticle

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