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http://dx.doi.org/10.14400/JDC.2018.16.12.533

An Analysis of the Disagreement in Disease Coding in South Korean Medical Institutions: Focusing on the Health Insurance Claim Data of Outpatients  

Jeon, Yun-Hee (Department of Medical Information, Chungcheong University)
Kang, Gil-Won (Department of Health Information and Management College of Medicine, Chungbuk National University)
Publication Information
Journal of Digital Convergence / v.16, no.12, 2018 , pp. 533-540 More about this Journal
Abstract
The purpose of this study was to use the data from the Health Insurance Review and Assessment Service to analyze the disagreement in disease coding given by different medical institutions on the same disease of the same patient and provide basic data that could help improve the quality of national public health statistics. 9,976,826 patients' data records from the Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) of 2014 were analyzed. The disagreement in disease coding differed by movement paths for medical institutions; the disagreement rate tended to increase when moving from a medical institution other than public health centers to a public health center and decrease remarkably when moving from a specialized general hospital to another. Therefore, this analysis of disagreement in disease coding among medical institutions suggests the need to supplement the system so that domestic medical institutions can realize consistent disease coding.
Keywords
Same disease; Disease coding; Medical institutions; Agreement; Disagreement;
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1 M. Farzandipour, A. Sheikhtaheri & F. Sadoug hi. (2010). Effective factors on accuracy of principal diagnosis coding based on international classification of diseases, the 10th revision (ICD-10). International Journal of Information Management, 30(1), 78-84. DOI : 10.1016 /j.ijinfomgt. 2009. 07. 002   DOI
2 WHO. (2016). International Classification of Diseases(ICD)-10.
3 J. H. Lee & M. S. Sim. (2009). The accuracy of the ICD-10 code for trauma patients visiting on emergency department and the error in the ICISS. Journal of the Korean Association of Traumatology, 22(1), 108-115. UCI : G704 -SER000001561. 2009.22.1.009
4 Y. H. Kim & K. H. Kim. (2015). Study about the relationship between Chief complaint of pure death patients using medical record information. Journal of Digital Convergence, 13(1), 407-414. DOI : 10.14400 / JDC. 2015. 13. 1. 407   DOI
5 Y. R. Song, M. S. Lee, D. R. Kim & K. H. Kim. (2017). A Convergence Study on the Characteristics of Length of Hospital Stays of Injured and Traumatic Death Patients - Based on the Korea National Hospital Discharge Injury Survey Data. Journal of the Korea Convergence Society, 8(5), 87-96. DOI : 10.15207/JKCS.2017.8.5.087   DOI
6 D. Lorence. (2003). Regional variation in m edical classification agreement: benchmar king the coding gap. Journal of Medical System, 27(5), 435-443 . DOI : https://doi.org/10.1023/A:1025607805588   DOI
7 K. H. Kim, Y. H. Kim, J. W. Park, S. Y. W On, H. Kang, H. Choi & S. T. Han. (2008). A study on the concordance rate between principal diagnosis on the Written request and final diagnosis of obstetrics and gynecologic patients. Journal of the Korean Data Analysis Society, 10(4B), 1923-1931. DOI : 10.15207/JKCS.2017.8.5.087
8 G. S. Lee. (1995). Diagnosis coding agre ement between medical records and medical claim billing data [dissertation]. Seoul National University; Korea.
9 Y. J. Kim, D. R. Kim & K. H. Kim. (2018). A Study on Clinical Characteristics of Patients with Mild Cognitive Impairment at Convalescent Hospitals. Journal of the Korea Convergence Society, 9(8), 77-85. DOI : 10.15207/JKCS.2018.9.8.077   DOI
10 J. Stausberg, N. Lehmann, D. Kaczmarek. & M. Stein. (2008). Reliability of diagnoses coding with ICD-10. International Journal of Medical Informatics, 77(2008), 50-57. DOI: 10.1016/j.ijmedinf.2006.11.005   DOI
11 http://www.koiha.kr/
12 O. R. Moon, C. Y. Kim & M. K. Kim. (1992). Individual variations in the code of the international classification of disease for similar outpatient conditions among general practitioners. Health Policy and Management, 2(1), 66-79.
13 Y. S. Seo, K. S. Lee, J. H. Park & S. H. Kang. (2010). A study on regional medical utilization variation of hospital inpatients in Korea, Journal of the Korea Academia-Industrial cooperation Society, 11(4), 1511-1519. UCI : G704 - 001653. 2010.11.4.037   DOI
14 S. O. Bae & G. W. Kang. (2015). A compar ative study of the disease codes between korean national health insurance claims and korean national hospital discharge in-depth injury survey. Journal of Health Policy and Management, 24(4), 322-329. DOI : 10.4332/KJHPA.2014.24.4.322
15 S. O. Bae, G. W. Kang, Y. Boo, Y. Lee, H. S. Choi & H. Y. Choi. (2015). A Study on the Difference in Disease Coding of Doctors, Medical Insurance Review Nurses and Medical Record Administrators based on Coding Simulation. Journal of Health Informatics and Statistics, 40(3), 161-174. UCI : G704-SER000008861.2015.40.3.015
16 Y. H. Jeon. (2018). Variation in disease coding by physician in Korea : based on outpatient claim data. Doctoral dissertation. Chungbuk National University, Cheongju Chungbuk.