This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
—We welcome Ms Amatayakul's clarifications. First, if DRG errors occurred at random, 50% would have overreimbursed the hospitals. The finding of 50.7%±2.6% compares with this proportion, not with total billing errors.Second, this study merely compares the DRG billed with the DRG supported by the medical record. It reaches no conclusions regarding intent.Third, this study compares the narrative diagnoses and procedures attested to by the attending physician, the numeric ICD-9-CM codes received by the fiscal intermediary, and the correct ICD-9-CM codes as reabstracted by the American Health Information Management Association (formerly American Medical Records Association). "Resequencing" therefore includes any changes to the correct sequence of principal and secondary diagnoses that occurred between the physician's attestation and their arrival at the fiscal intermediary. Amatayakul is correct that the alteration could have occurred in any department that handled the codes during this period. Administrative processing undoubtedly varies from hospital
Hsia DC, Ahern CA, Ritchie BP, Moscoe LM, Krushat WM. DRG Miscoding: Error or Intent?-Reply. JAMA. 1993;269(7):868. doi:10.1001/jama.1993.03500070047019
Customize your JAMA Network experience by selecting one or more topics from the list below.