Common errors and the audit checklist

Where coders actually go wrong

Where do coders actually go wrong? The evidence comes from national and hospital pilots, and from WHO's own rules.

Postcoordination is the weak point

A national pilot in China across fifty-nine hospitals tested coders on twenty-five cases. Accuracy with the full code scored was seventy-nine percent for cases needing postcoordination, against ninety-one percent for cases that did not. Most postcoordination errors were values that were missing. Mandatory causing-condition codes were often left out.

• Cases without postcoordination · 91.4
• Cases needing postcoordination · 79.1

Same pattern

A hospital pilot in Chile coded four hundred and fifty-seven discharges. Agreement on the principal diagnosis was ninety-six percent. The main errors were again omissions in postcoordination, and incorrect external cause codes.

• Principal diagnosis agreement · 96 · Physicians and coders, 457 discharges

Four rule errors

Eight errors worth knowing. One: an extension code with no stem code. Two: choosing unspecified by default when the detail was documented. Three: leaving out the postcoordination the record supports. And four: postcoordinating what one code already says.

• 1 Extension alone · Never · An extension code with no stem code.
• 2 Unspecified default · Z · Detail was documented but not used.
• 3 Detail left out · Omitted · Detail the record supports, not added.
• 4 Duplicating · Rebuilt · Rebuilding a code that already exists.

Four judgement errors

Five: putting two distinct concepts in one cluster. Six: a missing or incorrect external cause. Seven: linking conditions on an ambiguous word such as with, after or following. And eight: not verifying the result in the tabular list.

• 5 Mixed cluster · Mixed · Distinct conditions combined.
• 6 Wrong cause · External · Injury cause missing or incorrect.
• 7 Linked on a word · Ambiguous · With, after, in or following do not establish a cause.
• 8 Not verified · Skipped · Result not checked in the tabular list.

A nine-point audit checklist

Here is a nine point checklist. The main condition is the reason for admission. Other conditions that affected management are coded. Every code is as specific as the record allows. Unspecified only where detail is missing. No extension code without a stem code. Postcoordination used where documented, and never duplicating a code. Causing conditions coded where known. Injuries carry their external cause. And the result is verified in the tabular list.

• Main condition is the reason for admission
• Other conditions that affected management are coded
• Every code is as specific as the record allows
• Unspecified only where detail is missing
• No extension code stands without a stem code
• Postcoordination used where documented, never duplicating a code
• Causing conditions coded where known
• Injuries carry their external cause
• Result verified in the tabular list

Keep these in mind

Postcoordination is where errors concentrate. Most errors are omissions, not wrong codes. And audit against the nine points.

• Postcoordination is where errors concentrate
• Most errors are omissions, not wrong codes
• Audit against the nine points