CODING QUALITY IN ICD-10-CM

You have been the coding supervisor for about 2 months at General Hospital. You were told when hired that there were problems so you are prepared. You are setting in and getting a strong grasp of what has been happening in the areas of quality, quantity, work ethics, policies and so forth.

A baseline coding audit has identified that there is problem with the quality of coding performed. The audits show a wide range of problems across patient types, services, and coders. There is a lot of work, ahead of improve the coding function to achieve the desired 98% accuracy rate as the last audit showed only an 87% accuracy rate.

You decide to begin by conducting a face validity of the codes. You print a report of the most recent discharge diagnoses codes to see if you can identify any glaring problems.

Perform a face validity review of the 10 discharges shown in Table 5-2 to ensure compliance to official coding guidelines, which can be found in your code book or online. Report any coding quality issues you identify from your review. Table 5-2 is available

WORKSHEET FOR IDENTIIFYING CODIING QUALITY PROBLEMS

CASE 1 Principle Diagnosis: B96.20 Unspecified Escherichia coli as the cause of disease

classified elsewhere

Secondary Diagnosis: N39.0 Urinary tract infection, site not specified

Problem(s) Identified:

Coding Rule Violated:

CASE 2 Principle Diagnosis: A41.02 Methicillin-resistant Staphylococcus aureus sepsis

Secondary Diagnosis: B95. Methicillin-resistant Staphylococcus aureus as cause

of disease classified elsewhere

Problem(s) Identified:

Coding Rule Violated:

CASE 3 Principle Diagnosis: E10.1 Type 1 diabetes mellitus without complications

Secondary Diagnosis: E11.29 Type 2 diabetes mellitus with other diabetic kidney

complication

Problem(s) Identified:

Coding Rule Violated:

CASE 4 Principle Diagnosis: I11.0 Hypertensive heart failure

Secondary Diagnosis: I10 Hypertension

Secondary Diagnosis: I50.9 Heart failure, unspecified

Problem(s) Identified:

Coding Rule Violated:

CASE 5 Principle Diagnosis: R10.9 Unspecified abdominal pain

Secondary Diagnosis: K52.9 Noninfective gastroenteritis and colitis, unspecified

Problem(s) Identified:

Coding Rule Violated:

CASE 6 Principle Diagnosis: O80 Encounter for full term uncomplicated delivery

Secondary Diagnosis: Z38.0 Single liveborn infant, delivered vaginally

Problems Identified:

Coding Rule Violated: