Time Requirements for ICD-Coding of Diagnoses
DOI: 10.3238/zfa.2018.0209-0213german translation / full article
Background: In 2011, the planned implementation of Ambulant Coding Guidelines (AKR) for German doctors did in fact not take place. Now health insurances and the Federal Social Insurance Authority demand again their introduction to optimize the quality of the coding of diagnoses and the morbidity-adjusted risk compensation scheme (Morbi-RSA). How much time is required for AKR-coding compared to other methods?Methods: 32 family practitioners chosen in a German e-mail-forum agreed to measure the amount of time for the coding of nine typical chronic diseases using the international classification of diseases (ICD), a questionnaire and a stopwatch in three models: 1. the usual method, 2. using a list of codes on paper (CodA), categorized according to the International Classification of Primary Care (ICPC-2), or 3. a computer-assisted AKR-method. It was further analyzed whether the choice of methods would make any difference considering Morbi-RSA.Results: AKR-coding took three times longer than the other methods. Coding with the help of paper lists and by conventional methods, respectively, did not differ significantly. Medical correctness was similar with all three methods, however, none of them could reach the optimal financial effect for Morbi-RSA (usual coding –47 %, paper list –27 % and AKR –14 %).Conclusions: The higher time expenditure necessary for the detailed coding of diagnoses using ICD-10 GM 2011 with AKR results in only a minor improvement of the quality of coding.