title: Miscoding as a cause of elevated simple pneumonia mortality.
abstract: BACKGROUND
  An independent health care evaluating organization reported on the Internet that the 1996-1998 mortality rate for simple pneumonia (one of the diagnoses in diagnosis-related group [DRG] 89) was 11.06% (expected rate, 7.69%)--a rate much higher than suggested by the medical center's prospective quality surveillance. Chart review was undertaken to explain this reported higher mortality rate.
  
  
  METHODS
  Two-hundred forty-six charts of patients (123 expired, and 123 alive at discharge) were reviewed; each chart concluded with a principal diagnosis. The differences between the originally coded principal diagnosis and the recoded principal diagnoses were examined.
  
  
  RESULTS
  Application of Coding Clinic guidelines revealed that a principal diagnosis of simple pneumonia should have been coded in only 85 (34.6%) of the charts. The remaining charts should have been coded as respiratory failure (13.8%), congestive heart failure (11.4%), respiratory infections and inflammations (7.7%), and other diagnoses (32.5%). Coding occurred prior to discharge summary dictation in 48.4% of the cases. On the basis of the findings, the actual calculated mortality rate of simple pneumonia was 6.6%.
  
  
  CONCLUSIONS
  Coding in advance of discharge summary completion and nonexplicit documentation of the principal diagnoses occurred frequently. Reasons for miscoding included failure to distinguish between principal and final diagnoses, delay in discharge summary dictation, and inadequate documentation.
authors.affiliation: Department of Infection Control, Via Christi Regional Medical Center (VCRMC), Wichita, Kansas, USA.
authors.forename: Hewitt
authors.initials: H
authors.lastname: Goodpasture
authors.forename: Chau-Thuong
authors.initials: CT
authors.lastname: Nguyen-Dang
authors.forename: Tony H
authors.initials: TH
authors.lastname: Lee
authors.forename: Paula G
authors.initials: PG
authors.lastname: Ghazarian
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fulton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups / Q000145:classification; D004194:Disease / Q000145:classification; D005260:Female; D006302:Health Services Research; D006761:Hospitals / Q000592:standards; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D011014:Pneumonia / Q000401:mortality*; D019984:Quality Indicators, Health Care; D016896:Treatment Outcome; D014481:United States