Examining the reliability of ICD-10 discharge coding in Red Cross War Memorial Children’s Hospital administrative database

Abstract

Background. Discharge diagnostic data from hospital administrative databases are often used to inform decisions relating to a variety of vital applications. These may include the allocation of resources, quality-of-care assessments, clinical research and formulation of healthcare policy. Accurately coded and reliably captured patient discharge data are of paramount importance for any hospital and health system to function efficiently.

Objectives. To retrospectively examine the reliability of the International Classification of Diseases version 10 (ICD-10) discharge coding in Red Cross War Memorial Children’s Hospital (RCWMCH)’s administrative database for primary and secondary discharge diagnoses, and to formulate recommendations for improvement to the current system.

Methods. This study was a retrospective folder review of 450 patient admissions to the short-stay and general paediatric wards at RCWMCH between 1 August 2013 and 1 September 2014. The principal investigator (PI) completed ICD-10 discharge coding for each admission and compared it with the corresponding admission data captured for each patient in the Clinicom (Siemens Medical Solutions, Germany) health information system. Agreement comparison was done to 4- and 3-character ICD-10 code specificity.

Results. Of the initial 450 randomly selected folders, 396 (88%) were analysed during the folder review process. The median number of total diagnoses (primary diagnosis plus secondary diagnoses) coded by the PI folder review was 3, with a distribution of 1 - 10 (interquartile range (IQR) 2 - 4). The median number of total diagnoses coded in Clinicom was 1, with a distribution of 1 - 3 (IQR 1 - 1). Agreement of primary diagnosis coding to 4 characters was 26.3%, with slight improvement to 34.3% when assessed to 3 characters. Agreement of secondary diagnoses to 4 characters was 14.9%, and 27.7% when assessed to 3 characters.

Conclusions. Reliability of administrative ICD-10 discharge data from RCWMCH is poor. Inadequacies regarding the employment of dedicated and/or adequately trained coding personnel may significantly contribute to the problem and should be addressed.