title: Quality improvement of International Classification of Diseases, 9th revision, diagnosis coding in radiation oncology: single-institution prospective study at University of California, San Francisco.
abstract: OBJECTIVE
  Accurate International Classification of Diseases (ICD) diagnosis coding is critical for patient care, billing purposes, and research endeavors. In this single-institution study, we evaluated our baseline ICD-9 (9th revision) diagnosis coding accuracy, identified the most common errors contributing to inaccurate coding, and implemented a multimodality strategy to improve radiation oncology coding.
  
  
  METHODS
  We prospectively studied ICD-9 coding accuracy in our radiation therapy--specific electronic medical record system. Baseline ICD-9 coding accuracy was obtained from chart review targeting ICD-9 coding accuracy of all patients treated at our institution between March and June of 2010. To improve performance an educational session highlighted common coding errors, and a user-friendly software tool, RadOnc ICD Search, version 1.0, for coding radiation oncology specific diagnoses was implemented. We then prospectively analyzed ICD-9 coding accuracy for all patients treated from July 2010 to June 2011, with the goal of maintaining 80% or higher coding accuracy. Data on coding accuracy were analyzed and fed back monthly to individual providers.
  
  
  RESULTS
  Baseline coding accuracy for physicians was 463 of 661 (70%) cases. Only 46% of physicians had coding accuracy above 80%. The most common errors involved metastatic cases, whereby primary or secondary site ICD-9 codes were either incorrect or missing, and special procedures such as stereotactic radiosurgery cases. After implementing our project, overall coding accuracy rose to 92% (range, 86%-96%). The median accuracy for all physicians was 93% (range, 77%-100%) with only 1 attending having accuracy below 80%. Incorrect primary and secondary ICD-9 codes in metastatic cases showed the most significant improvement (10% vs 2% after intervention).
  
  
  CONCLUSIONS
  Identifying common coding errors and implementing both education and systems changes led to significantly improved coding accuracy. This quality assurance project highlights the potential problem of ICD-9 coding accuracy by physicians and offers an approach to effectively address this shortcoming.
authors.affiliation: Department of Radiation Oncology, Scripps Clinic, San Diego, California.
authors.forename: Chien P
authors.initials: CP
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
authors.forename: Steve
authors.initials: S
authors.lastname: Braunstein
authors.affiliation: Department of Medicine, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mourad
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
authors.forename: I-Chow J
authors.initials: IC
authors.lastname: Hsu
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
authors.forename: Daphne
authors.initials: D
authors.lastname: Haas-Kogan
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California.
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco (UCSF), School of Medicine, San Francisco, California. Electronic address: FoghSE@radonc.ucsf.edu.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Fogh
mesh_terms: D059019:Clinical Coding / Q000379:methods* / Q000592:standards*; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D006268:Health Facilities; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards*; D008297:Male; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000532:radiotherapy*; D011446:Prospective Studies; D058996:Quality Improvement; D018787:Radiation Oncology / Q000379:methods*