Work

Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research

Year: 2025

Type: article

Abstract: Background: The main data basis for the Diagnosis-Related Group(DRG) payment methodology is the disease diagnosis and clinical codes in the Medical Record(MR) . Problems such as up-coding have arisen during implementation in many countries, and problems with MR quality and solutions have been studied mostly from the physician's perspective. We investigated and analyzed the main influences on clinical coding from the perspectives of directors and coders in Medical Records Section(MRS) to provide recommendations for improvements in data quality. Methods: The questionnaire was developed, revised and improved using literature research and expert consultation methods. From June 13th to June 19th, 2024, the electronic questionnaire survey was conducted among the directors and coders of medical records department in healthcare organization. A total of 484 directors and coders were included in this study. And relevant statistics were computed and analyzed by non-parametric tests. Results: The results showed that the male-to-female ratio is about 1:2, and the ratio of MRS directors to coders is about 1:3. The highest proportion of bachelor's degree is 65.3%, with 29.5% having a major in Health Information Management(HIM), and 70.7% holding junior and intermediate professional titles. Coders should possess strong job responsibilities (92.36%), coding skills (91.33%), knowledge of clinical medicine(90.70%), and other comprehensive qualities and abilities. When encountering difficult problems, the clinical coders should first communicate with clinical doctors (91.95%). The two main factors affecting the quality of MR and clinical coding are the individual factors of doctors (88.84%) and the individual factors of coders (85.54%). Conclusions: Doctors and coders are the primary factors influencing the quality of clinical coding. It is recommended to establish a systematic training program for doctors to enhance the connotative quality of MR, for coders to solidify professional coding skills, strengthen communication and exchange, adopt reasonable behaviors, avoid moral hazards, and effectively improve the quality of clinical coding.

Source: Healthcare

DOI: 10.3390/healthcare13080849

Authors: Yinghong Fu, Guangying Gao, Huiying Xing, Shanshan Dai, Xinyu Cai, Jiashuai Tian

Institution: Capital Medical University

Language: English

Topic: Medical Coding and Health Information

Subfield: Health Information Management

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,258