Provisional Coding Practices: Are They Really a Waste of Time?

Abstract

In order to facilitate effective clinical coding and hence the precise financial reimbursement of acute services, in 2005 Western District Health Service (WDHS) (located in regional Victoria, Australia) undertook a provisional coding trial for inpatient medical episodes to determine the magnitude and accuracy of clinical documentation.

Utilising clinical coding software installed on a laptop computer, provisional coding was undertaken for all current overnight inpatient episodes under each physician one day prior to attending their daily ward round. The provisionally coded episodes were re-coded upon the completion of the discharge summary and the final Diagnostic Related Group (DRG) allocation and weight were compared to the provisional DRG assignment.

A total of 54 out of 220 inpatient medical episodes were provisionally coded. This represented approximately a 25% cross section of the population selected for observation. Approximately 67.6% of the provisionally allocated DRGs were accurate in contrast to 32.4% which were subject to change once the discharge summary was completed. The DRG changes were primarily due to: disease progression of a patient during their care episode which could not be identified by clinical coding staff due to discharge prior to the following scheduled ward round; the discharge destination of particular patients; and the accuracy of clinical documentation on the discharge summary. The information gathered from the provisional coding trial supported the hypothesis that clinical documentation standards were sufficient and adequate to support precise clinical coding and DRG assignment at WDHS. The trial further highlighted the importance of a complete and accurate discharge summary available during the coding process of acute inpatient episodes.