Online Program

Analysis of coding quality in Germany using health insurance billing data – utilization of qualifying characters in the documentation of diagnoses

Tuesday, November 5, 2013

Anja Schramm, Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany
Joerg Klewer, MD PhD, Faculty of Public Health and Nursing Sciences, University of Applied Sciences Zwickau, Zwickau, Germany
Joachim Kugler, MD PhD, Department of Health Sciences / Public Health, Dresden Medical School, TU Dresden, Dresden, Germany
Background: As a part of the health care reform 2007 the German risk structure compensation scheme was extended as to connect the financial cash flow towards the payers to morbidity information from outpatient care. The aim of this study was to evaluate coding quality via qualifying characters as well as to identify future challenges. Methods: The study sample included about 350 million diagnoses which were qualified as “assured” or “post-treatment” of about 11k practitioners' treatment of 2.7 million AOK PLUS insurants in Saxony and Thuringia (Germany) during the years 2007 to 2010. We focused on the following four ICD-10-GM Codes: I21, I25, I63 and I64. Results: The number of “post-treatment” diagnoses generally rose from year to year. In the first quarter 2007, 78,097 insurants got a post-treatment diagnosis and in the fourth quarter 2010 91,796. According to the insurants' view it has indicated that this caused not because of short but long coding traditions. 13,947 insurants (I21: 4,953, I25: 1,358, I63: 2,944, I64: 4,692) were identified with a total coding tradition (16 quarters). In particular, general practitioners tend to use this diagnosis codes qualified as “post-treatment” for conditions after certain events. The two sample t-test to the change of the mean coding quality suggest at p<0.01-level an improvement from 2008 to 2010. Conclusion: We identified a lack of diagnosis coding precision regarding the condition after certain medical events. Consequently, we expect adverse effects evaluating the cost of diseases as only “assured” diagnoses are considered within the risk transfer compensation scheme.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the outpatient coding quality in Germany. Demonstrate the hazard of adverse effects in cause of the use diagnosis codes qualified as “post-treatment” for the risk structure compensation scheme.

Keyword(s): Health Care Reform, Public Health Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I made substantial contributions to conception and design, analysis and interpretation of the study data. I am involved in research projects regarding outpatient coding quality and health care management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.