Online Program

Analysis of outpatient coding quality in german disease management programs

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: The German health care reform act, which came in force 2011, canceled the outpatient coding reference. Firstly, the outpatient coding reference should have been the basis for the German risk structure compensation scheme, which was started in 2009. The aim of this study was to evaluate coding quality in Disease Management Programs (DMP). Methods: This study analyzed 350 million diagnoses of 2.7 million AOK PLUS insurants and 11k practitioners' in Saxony and Thuringia (Germany) from 2007 to 2010. We focused on the hypothesis that an insurant, which was registered in a DMP, had to get specific program diagnosis. For indication diagnoses were chosen ICD-10-GM I20 to I25 for CHD, J45 and J46 for asthma, J44 for COPD and E11 to E14 for diabetes mellitus. Results: During the years 2007 to 2009 we identified a lack of diagnoses for the insurants inside a DMP. In 2010 the number of falsely coded insurants decreased from 9,206 to 1,839. According to the DMP the analysis suggest that diabetes mellitus patients were the best coded group with the least error ratio (2007: 0.31%, 2008: 0.24%, 2009: 0.16%, 2010: 0.06%). The worst outpatient coding quality was caused in the DMP CHD (2007: 9.42%, 2008: 10.12%, 2009: 9.22%, 2010: 1.33%). Conclusion: Study findings suggest that the outpatient coding quality escalated in 2010. The AOK PLUS advised 2010 general practitioners to the coding quality according to the DMP insurants. So, the changes can be explained because of this intervention and not to an independent attitude change.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the outpatient coding quality in Disease Management Programs in Germany. Demonstrate the importance of the outpatient coding reference for the risk structure compensation scheme.

Keyword(s): Disease Management, Coding

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.