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Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Since the RAF for each patient is recalculated each year, all chronic conditions must be diagnosed, treated, and coded at least once each CY in order to accurately calculate risk-adjustment and budget the appropriate amount of money to care for that patient in the next CY.29 All ICD-10-CM billing codes must be supported by documentation of a visit between the provider and patient, and documentation sources can include anything in an inpatient or outpatient visit.
The Initial Metabolic Medicine Hospital Consult
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
In the era of physician–hospital partnership and the spirit of teamwork, I believe we should include an ICD-10 code for the diagnosis. Adding this code to your consult will help the hospital records department code the case correctly. It also reminds your colleagues about the economic impact of malnutrition on the overall patient costs. This, in turn, raises the impact factor for our input in the case.
Psychiatry
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Without utilizing a mutually agreed classification system, each psychiatrist would employ their own idiosyncratic classification. This would make it impossible to communicate, render research impossible, and every clinician would have to write their own textbook! For legal purposes, requiring each expert to employ the same set of diagnostic rules allows for a common language that both sides can understand. It gives both sides in court the opportunity to refer to standard textbooks2,3 for descriptions of the condition and allows for focussed cross-examination. The two most important diagnostic systems employed in psychiatry are: the International Classification of Diseases, now in its 10th edition, abbreviated as ICD-10.4the diagnostic and statistical manual of the American Psychiatric Association, edition 4, abbreviated as DSM-IV.5
Accuracy of the International Classification of Diseases, 9th Revision for Identifying Infantile Eye Disease
Published in Ophthalmic Epidemiology, 2022
Timothy T. Xu, Cole E. Bothun, Tina M. Hendricks, Sasha A. Mansukhani, Erick D. Bothun, Launia J. White, Brian G. Mohney
Given the ICD-9’s expansive nature of over 12,000 diagnostic and 3,500 procedure codes, factors that contribute to imprecise claims data coding and variable ICD-9 accurate rates include unintentional and intentional coding errors (e.g., upcoding, misspecification, incorrect unbundling of codes), a lack of institutional quality control efforts, and variations in coder training and experience.3,15 Many ICD-9 codes have broad descriptions and are used for a wide range of diagnoses, thereby rendering many of them non-specific.16 Inaccurate coding may also represent the omission of billing codes by busy providers. If a patient was diagnosed with multiple conditions, it is possible that the provider billed for only one of the diagnoses, thus claims data would fail to capture diagnoses that were not assigned ICD-9 codes.
The most common comorbidities in patients with Ehlers-Danlos syndrome: a 15-year nationwide population-based cohort study
Published in Disability and Rehabilitation, 2022
Julie Leganger, Siv Fonnes, M. L. Kulas Søborg, Jacob Rosenberg, Jakob Burcharth
The main strength of this study was its nationwide population-based design in the setting of a health care system freely available to all citizens in the country. The Danish population has relatively stable and homogeneous demography concerning race and religion [16]. These features ensure the generalizability of our results and minimize selection bias. Our study also had some limitations. We did not have access to individual patient files and therefore it was impossible to group the EDS cohort by subtype and examine a possible difference. Furthermore, the reporting system of ICD-10 codes in the DNPR may theoretically bear a risk of some degree of a coding error. However, the DNPR has been confirmed as a valid source of research information in multiple studies [16]. Moreover, complete registration in the DNPR has been promoted financially through the introduction of the Diagnosis-Related Group system in 2002 [16]. DNPR only contains hospital admissions, thus, other important health issues such as dental health could not be assessed in this study. Another limitation was the explorative study design, which investigated all ICD-10 codes registered. ICD-10 codes reflect the coding preference of individual physicians or departments. The ICD-10 code registered might be one of many ICD-10 codes used to describe a specific disease, which should be kept in mind when interpreting the results.
Risk of developing major depressive disorder in polycystic ovary syndrome: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2021
In Ok Lee, Jung Chul Kim, Jong Wook Seo, Hae Yong Pak, Jae Eun Chung
Instituted in 2005, the Korean National Health Insurance Claims Database contains comprehensive data regarding patients’ diagnostic codes in International Classification of Diseases (ICD-10 code), procedures undertaken (including major and minor operations), prescribed medications, and reimbursed medical costs in both outpatient and hospital admission settings. The ICD-10 codes were registered by the clinician who treated the patient through the electronic medical record system. The Korean National Health Information Database comprises a patient’s body mass index (BMI), blood pressure, cholesterol, fasting blood sugar, haemoglobin, triglycerides, smoking habits, socio-economic status, and residential area at the time of his or her biennial health check-up. These data sets are managed and publicly released by the National Health Insurance Corporation for research purposes, and the patient’s confidentiality is maintained accordingly. No patient healthcare records are duplicated because all Korean residents receive a unique identification number (Seong et al. 2017; Seong et al. 2017).