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Poor code quality impacts on the management of the specialist health service

​Poor quality medical coding leads to many errors in the health statistics and therefore has negative consequences for the management and financing of the specialist health service. "The health enterprises must ensure that doctors receive adequate training concerning coding", says Auditor General Per-Kristian Foss.

Published 3/23/2017 12:00 PM

​Document 3:5 (2016–2017) The Office of the Auditor General's investigation of medical coding practice within the health enterprises was submitted to the Storting on 23 March.

Medical coding entails converting textual descriptions of diagnoses and procedures in patient medical records into codes. Using medical codes, the information provided in patient medical records can be used for statistical purposes, health monitoring, research and the management and financing of the health enterprises. The health enterprises have a responsibility to send codes to the Norwegian Patient Register (NPR) following all hospital admissions.

"The Office of the Auditor General's investigation has revealed that code quality is poor. There are unacceptably large differences between the codes reported to the Norwegian Patient Register and the information given in the patients' medical records," says Auditor General Per-Kristian Foss.

The Office of the Auditor General used two patient groups as a basis for its investigation: pneumonia patients and hip replacement patients. Amongst the pneumonia patients, an incorrect principal diagnosis was reported for 41% of all admissions. The principal diagnosis is the medical problem at which medical assistance is primarily aimed during a particular hospital admission.

"This reduces the quality of the patient statistics, which in turn means that the basis for managing the health enterprises will be deficient", says Foss.

The Office of the Auditor General believes that the most important measure to improve code quality is to raise the level of knowledge concerning coding amongst the stakeholders concerned.

"Within many health enterprises, training is targeted at intern doctors, but experienced doctors must also be given good and up-to-date knowledge. This is important, as these doctors often guide and assure the quality the coding of younger doctors", says Foss.

The health enterprises have a responsibility to manage and lead the work relating to coding. The Office of the Auditor General stresses that clear management which supports the code work is vital. The hospital in Stavanger came out well in the investigation in that it had fewer incorrect reports than the other hospitals regarding the pneumonia patients.

"At the hospital in Stavanger, the CEO and other managers have made it clear that coding is important and that it must be done correctly. This is an example which should be emulated", says the Auditor General.

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