[Study of the quality of codification of diagnoses and procedures under DRG conditions].
A system based on Diagnosis Related Groups was introduced in Germany and is mandatory for hospitals from 2004. Hospitals, health care providers and the Medical Service of Social Security-Health Insurance (MDK) face a common effort. Proper codification of diagnoses and procedures is essential. The Medical Service in the State of Hessen, the Techniker Krankenkasse and the Burgerhospital Frankfurt am Main combined forces to assess codification under the DRG system.


OBJECTIVE
The partners cooperated to assess actual codification and to identify starting points for improvement.


METHODS
A random sample was taken from all in-patient cases (all departments) over a 6-month-period (n = 309). Codification or coding was checked according to German Coding Rules (Deutsche Kodierrichtlinien) from the complete hospital records. Different codification, or coding, was discussed between MDK and Hospital doctors.


RESULTS
The actual data revealed overcoding in 34 per cent of diagnoses and in 15 per cent of procedures. Undercoding was present in 9 per cent of diagnoses and in 2 per cent of procedures. The DRG grouping changed in 68 cases (22 per cent) after scrutiny by the Medical Service (MDK). The case-mix index (CMI) calculated from relative weights as coded by the hospital was 0.84. The case-mix index calculated from coding by MDK was 0.81. The CMI calculated from effective weights was 0.77 (hospital) and 0.75 (MDK).


CONCLUSIONS
Causes of faulty coding and possible remedies are presented.


CONCLUSIONS
Further systematic reviews are required to develop the DRG System and identify faulty trends.
Klaus
B
B
Medizinischer Dienst der Krankenversicherung in Hessen, Oberursel. b.klaus@mdk-hessen.de
Ritter
A
A
Grosse Hülsewiesche
H
H
Beyrle
B
B
Euler
H-U
HU
Fender
H
H
Hübner
M
M
von Mittelstaedt
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003953:Diagnosis-Related Groups / Q000592:standards*; D005260:Female; D005858:Germany; D006753:Hospital Records; D006801:Humans; D008297:Male; D008875:Middle Aged; D012494:Sampling Studies; D013997:Time Factors; D017749:Total Quality Management