Original Article
Korean J Prev Med. 2000; 33(1): 76-82.
The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims.
Jong Ku Park, Ki Soon Kim, Chun Bae Kim, Tae Yong Lee, Kang Sook Lee, Duk Hee Lee, Sunhee Lee, Sun Ha Jee, Il Suh, Kwang Wook Koh, So Yeon Ryu, Kee Ho Park, Woonje Park, Seungjun Wang, Hwasoon Lee, Yoomi Chae, Hyensook Hong, and Jin Sook Suh
1Department of Preventive Medicine, Yonsei University Wonju College of Medicine.
2Department of Preventive Medicine, College of Medicine, Chosun University.
3Department of Preventive Medicine and Public Health, College of Medicine, Chungnam National University.
4Department of Preventive Medicine, Catholic University Medical College.
5Department of Preventive Medicine, College of Medicine, Kosin University.
6Department of Preventive Medicine, Medical College of Ewha Womens University.
7Graduate School of Health Science and Management, Yonsei University.
8Department of Preventive Medicine and Public Health, Yonsei University College of Medicine.
9Korean Medical Record Association.
OBJECTIVES: We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. METHODS: A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. RESULTS: The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. CONCLUSION: The accuracy rate of the ICMIC was 83.0%.
Keywords : Nationwide surveillance system;Medical insurance claims;Accuracy;Cerebrovascular diseases