# Presentation: 087692

## Improving State Hospital Discharge Data: Insight from a 19-State AnalysisBruce A LawrenceHarold B WeissTed R Millerlawrence@pire.org

## E-coded 19-State Hospital Discharge Data Set, 1997

**>50% of the US population**

## Coding Standards in 23 States

## Intensively Cleaned Dxs & E Codes

**17.7 M discharges**
**Selected injuries by Dx or E code**
**6.8% (1.21 M) injury discharges**
**Dropped late effects & rehab admits**
**1.13 M acute injury discharges**
**93.4% of injuries were acute:  ****ranged from 90% in NH & WA to 96% in NJ**

## 88.1% E Coded  

**88.1% E Coded  **

**>90%**

**85-89%**

**75-79%**

**65-70%**

## 5.1% E Coded As Other/ Unspecified

**5.1% E Coded As Other/ Unspecified**

**1.6%-2.9%**

**3.0%-4.9%**

**5.0-7.0%**

**11.9%**

## 230,000 cases where the principal diagnosis was not acute injury: 22.3% of all acute injuries

|  | Diagnosis description | Most Common Conditions |
| --- | --- | --- |
| 0.5% | Infectious/parasitic disease | Septicemia |
| 0.5% | Neoplasms | Lung cancer |
| 1.3% | Endocrine/nutrition/metabolic/immunity/blood | Volume depletionDiabetes |
| 4.1% | Mental disorders | Major depression |
| 0.6% | Nervous system & sense organs | EpilepsyAlzheimer's |
| 3.4% | Circulatory system | Heart failureAtrial fibrillation |
| 2.2% | Respiratory system | Pneumonia |

## Slide 8

|  | Diagnosis description | Most Common Conditions |
| --- | --- | --- |
| 1.1% | Digestive system | Intestinal obstruction |
| 0.6% | Genitourinary system | Urinary tract infection |
| 0.4% | Complications of pregnancy/childbirth | Early or threatened labor |
| 1.7% | Skin & subcutaneous tissue | Cellulitis & abscess |
| 1.8% | Musculoskeletal system & connective tissue | Pathological fracture |
|  | 	 |  |

## Slide 9

|  | Diagnosis description | Most Common Conditions |
| --- | --- | --- |
| 2.5% | Symptoms, signs, ill-defined conditions | Syncope & collapse |
| 0.2% | Adverse effects | Angioneurotic edema |
| 0.4% | Complications of surgical/medical care | Mechanical complication of implant |
| 0.9% | Factors influencing health status | Observation |

## Searched All Fields for a Valid Primary Injury Diagnosis

**Primary injury diagnosis is generally of good quality**
**98.1% specific, including just 2.7% not in the 800-995 range**
**1.1% other/unspecified**
**0.8% E code but no injury Dx**
**4.1%-4.4% E code but no injury Dx in UT & VA; 20% self-inflicted**

## Common Data Problems

**Invalid Dxs & E codes**
**- Isolated typos**
**- Systematic facility-specific miscoding**
**Misuse of E codes**
**- Falls that do not cause treated injury**
**- Overexertion for heart/respiratory conditions**
**- Intracranial hemorrhage coded as illness to increase reimbursement**
**Inconsistency between Dx & E codes for substances involved in poisoning**
**Duplicate records: the old record is not deleted when a record is updated/corrected**

## 5 of 22 states had readmission tags or encrypted patient IDs: 4%-8% are readmits

## Conclusion

**Need to clean state HDS data & related HCUP National Inpatient Sample injury data before using them: hard w/o hospital IDs - major HCUP NIS limitation**
**Other/unspecified E codes or E codes w/o injury Dxs are problems in some states**
**6.6% of injury discharges are late effects or rehab**
**4%-8% of acute injury discharges are readmissions**

**The principal Dx field codes a complication rather than the underlying injury in 17-22% of cases. We advise scanning 3 Dxs + E codes to identify injury discharges. A study is needed to see if cases with complications codes listed first have bad long-term outcome**
**Only 2.7% of E-coded cases had primary injury Dxs below 800. These typically were back injury, cellulitis & abscess, maternal injury, coma, or anoxic brain damage.**
**Need standardized US codes for payer type**
**States need to adopt the standard codes that have been established**