The improvement of coding with paramedical information

Abstract

The medical coding allows to report all inpatient complications, such as infections or malnutrition. These increase the cost of care, and therefore the reimbursement by the National Health Insurance. Paramedical records can be used to argue the occurrence of inpatient complications in case of inspection. Objective: To assess the contribution of nurses and dieticians to inpatient medical coding and valorization. Material and methods: Paramedical records from two medical and three surgical departments of Bichat hospital in Paris, France, were reviewed. Between April 2014 and February 2015, the hospital stays of 4 days or longer and with the lowest severity level were selected. If comorbidities or complications were present, the corresponding ICD-10 codes were added as secondary diagnoses. The length of stay was compared between recoded stays and the others. In dedicated file, the malnutrition codes were added only when the formal criteria were met. Valorization before and after control were compared. Results: For 26,2% of hospital stays out of 503, one or several codes were added. The recoded stays were longer than the others. The codes for “anaemia”, “diabetes” and “malnutrition” were the most frequently added. Malnutrition was justified for 32 patients out of the 49 registered in the dieticians’ file. Increased reimbursement valuation associated with nursing records was of 336 216€, and of 52 547€ for the use of the dieticians’ file. Discussion: The medical coding could reflect the involvement of nurses and dieticians in acute healthcare, but the reporting of complications and malnutrition must be simplified and promoted.