Study on Summary of Discharge Diagnosis (ICD-10 and ICD-9 CM) and Hospital Fee Reimbursement Based on Diagnosis Related Group System at Hospital for Tropical Diseases Study on Summary of Discharge Diagnosis (ICD-10 and ICD-9 CM) and Hospital Fee Reimbursement Based on Diagnosis Related Group System at Hospital for Tropical Diseases

Abstract

Summary discharge diagnosis using ICD-10 and ICD-9 CM directly affects the adjusted Relative Weight (AdjRW) and hospital fee reimbursement. We conducted this study to detect the differences between the summary discharge diagnosis from attending physicians and the Auditor. We also assessed the impacts of these differences on Diagnosis Related Group (DRG), AdjRW and calculated hospital fee reimbursement. The hospital records of admitted patients during October 2013 to April 2014 were reviewed.

Results: Altogether 1,107 hospital records were reviewed. Differences in term of errors or discrepancies in summary discharge diagnosis between attending physicians and auditor were found in 322 records, 216 of which affected DRG. After revision by an auditor, AdjRW increased by 182.84 points leading to increment of hospital fee reimbursement by 2,420,928.35 Baht.

Conclusion: This study showed that the differences in summary discharge diagnosis based on ICD-10, ICD-9 CM affected the DRG, AdjRW and hospital fee reimbursement. Therefore attending physicians should recognize the importance of completion of summary discharge diagnosis. Implementation of real time audit by the expert auditor could help making summary discharge diagnosis more complete and accurate.