title: Are central hospitals ready for National Health Insurance? ICD coding quality from an electronic patient discharge record for clinicians.
abstract: BACKGROUND
  South Africa (SA)'s planned National Health Insurance reforms require the use of International Statistical Classification of Diseases (ICD) codes for hospitals to purchase services from the proposed National Health Authority. However, compliance with coding at public hospitals in the Western Cape Province has been challenging. A computer application was developed to aid clinicians in integrating ICD coding into the patient hospital discharge process.
  
  
  OBJECTIVE
  To evaluate the quality of ICD codes captured using the application and predictors thereof in a single hospital department.
  
  
  METHODS
  After 6 months, the quality of ICD codes was determined by comparing ICD code descriptors with medical concepts in a random sample of original patient records selected over a 6-week period. Patient and personnel characteristics influencing quality of coding, derived from a theoretical framework, were collected.
  
  
  RESULTS
  Of 223 patient records, 45.3% (95% confidence interval (CI) 38.8 - 51.9) had complete ICD codes. Primary ICD code accuracy was 74.0% (95% CI 67.8 - 79.5). Patient characteristics such as female gender, younger age group and fewer comorbidities, as well as seniority of clinician rank, were significantly associated with ICD coding being complete on adjusted analysis.
  
  
  CONCLUSIONS
  The results of this study describe ICD coding quality at a central hospital in SA supported by a computer application and the factors influencing this. More interventions are required to achieve reliable coding data, such as additional ICD coding validation tools, training and oversight of junior clinicians.
authors.affiliation: Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa; Western Cape Government Department of Health, Cape Town, South Africa. robin.dyers@westerncape.gov.za.
authors.forename: Robin Edgar
authors.initials: RE
authors.lastname: Dyers
authors.forename: Juliet
authors.initials: J
authors.lastname: Evans
authors.forename: Grant Alex
authors.initials: GA
authors.lastname: Ward
authors.forename: Shane
authors.initials: S
authors.lastname: Du Plooy
authors.forename: Hassan
authors.initials: H
authors.lastname: Mahomed