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American Journal of Public Health, Vol. 82, Issue 2 243-248, Copyright © 1992 by American Public Health Association

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The accuracy of Medicare's hospital claims data: progress has been made, but problems remain.

E S Fisher, F S Whaley, W M Krushat, D J Malenka, C Fleming, J A Baron and D C Hsia

Department of Medicine, Dartmouth Medical School, Hanover, NH 03755-3862.

BACKGROUND. Health care databases provide a widely used source of data for health care research, but their accuracy remains uncertain. We analyzed data from the 1985 National DRG Validation Study, which carefully reabstracted and reassigned ICD-9-CM diagnosis and procedure codes from a national sample of 7050 medical records, to determine whether coding accuracy had improved since the Institute of Medicine studies of the 1970s and to assess the current coding accuracy of specific diagnoses and procedures. METHODS. We defined agreement as the proportion of all reabstracted records that had the same principal diagnosis or procedure coded on both the original (hospital) record and on the reabstracted record. We also evaluated coding accuracy in 1985 using the concepts of diagnostic test evaluation. RESULTS. Overall, the percentage of agreement between the principal diagnosis on the reabstracted record and the original hospital record, when analyzed at the third digit, improved from 73.2% in 1977 to 78.2% in 1985. However, analysis of the 1985 data demonstrated that the accuracy of diagnosis and procedure coding varies substantially across conditions. CONCLUSIONS. Although some diagnoses and all major surgical procedures that we examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential.




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M. D. Grant, M. A. Rudberg, and J. A. Brody
Gastrostomy Placement and Mortality Among Hospitalized Medicare Beneficiaries
JAMA, June 24, 1998; 279(24): 1973 - 1976.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
R. J. Mullins, N. C. Mann, J. R. Hedges, W. Worrall, M. Helfand, A. D. Zechnich, and G. J. Jurkovich
Adequacy of Hospital Discharge Status as a Measure of Outcome Among Injured Patients
JAMA, June 3, 1998; 279(21): 1727 - 1731.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
J. G. Jollis and P. S. Romano
Pennsylvania's Focus on Heart Attack -- Grading the Scorecard
N. Engl. J. Med., April 2, 1998; 338(14): 983 - 987.
[Full Text]

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 American Journal of Medical QualityHome page
J. Whittle, M. J. Fine, D. Z. Joyce, J. R. Lave, W. W. Young, L. J. Hough, and W. N. Kapoor
Community-Acquired Pneumonia: Can It Be Defined with Claims Data?
American Journal of Medical Quality, December 1, 1997; 12(4): 187 - 193.
[Abstract] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
R. Cydulka, E. McFadden Jr, C. Emerman, L. Sivinski, W Pisanelli, and A. Rimm
Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease
Am. J. Respir. Crit. Care Med., December 1, 1997; 156(6): 1807 - 1812.
[Abstract] [Full Text]

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 Arch Pediatr Adolesc MedHome page
W. O. Cooper, C. F. Federspiel, M. R. Griffin, and G. B. Hickson
New Use of Anticonvulsant Medications Among Children Enrolled in the Tennessee Medicaid Program
Arch Pediatr Adolesc Med, December 1, 1997; 151(12): 1242 - 1246.
[Abstract] [PDF]

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 JBJSHome page
T. FACISZEWSKI, S. K. BROSTE, and D. FARDON
Quality of Data Regarding Diagnoses of Spinal Disorders in Administrative Databases. A Multicenter Study
J. Bone Joint Surg. Am., October 1, 1997; 79(10): 1481 - 8.
[Abstract] [Full Text]

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 Eval Health ProfHome page
J. B. Fowles, E. Fowler, C. Craft, and C. E. McCoy
Comparing Claims Data and Self-Reported Data with the Medical Record for Pap Smear Rates
Eval Health Prof, September 1, 1997; 20(3): 324 - 342.
[Abstract] [PDF]

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 Arch Intern MedHome page
M. E. Mussolino, A. C. Looker, J. H. Madans, D. Edelstein, R. E. Walker, E. Lydick, R. S. Epstein, and A. J. Yates
Phalangeal Bone Density and Hip Fracture Risk
Arch Intern Med, February 24, 1997; 157(4): 433 - 438.
[Abstract] [PDF]

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 JAMAHome page
S. B. Soumerai, T. J. McLaughlin, D. Spiegelman, E. Hertzmark, G. Thibault, and L. Goldman
Adverse Outcomes of Underuse of {beta}-Blockers in Elderly Survivors of Acute Myocardial Infarction
JAMA, January 8, 1997; 277(2): 115 - 121.
[Abstract] [PDF]

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 Arch Intern MedHome page
R. M. Siddique, M. I. Siddique, A. F. Connors Jr, and A. A. Rimm
Thirty-Day Case-Fatality Rates for Pulmonary Embolism in the Elderly
Arch Intern Med, November 11, 1996; 156(20): 2343 - 2347.
[Abstract] [PDF]

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 American Journal of Medical QualityHome page
R. Hand, L. Klemka-Walden, and D. Inczauskis
Rural Hospital Mortality for Myocardial Infarction in Medicare Patients in Illinois
American Journal of Medical Quality, September 1, 1996; 11(3): 135 - 141.
[Abstract] [PDF]

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 Arch NeurolHome page
M. Monane, D. S. Kanter, R. J. Glynn, and J. Avorn
Variability in Length of Hospitalization for Stroke: The Role of Managed Care in an Elderly Population
Arch Neurol, September 1, 1996; 53(9): 875 - 880.
[Abstract] [PDF]

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 JAMAHome page
M.-C. Corti, J. M. Guralnik, M. E. Salive, T. Harris, T. S. Field, R. B. Wallace, L. F. Berkman, T. E. Seeman, R. J. Glynn, C. H. Hennekens, et al.
HDL Cholesterol Predicts Coronary Heart Disease Mortality in Older Persons
JAMA, August 16, 1995; 274(7): 539 - 544.
[Abstract] [PDF]

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 American Journal of Medical QualityHome page
R. L. Kalish, J. Daley, C. C. Duncan, R. B. Davis, G. A. Coffman, and L. I. Iezzoni
Costs of Potential Complications of Care for Major Surgery Patients
American Journal of Medical Quality, March 1, 1995; 10(1): 48 - 54.
[Abstract] [PDF]

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 Arch Intern MedHome page
W. H. Giles, R. F. Anda, M. L. Casper, L. G. Escobedo, and H. A. Taylor
Race and Sex Differences in Rates of Invasive Cardiac Procedures in US Hospitals: Data From the National Hospital Discharge Survey
Arch Intern Med, February 13, 1995; 155(3): 318 - 324.
[Abstract] [PDF]

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 Arch Intern MedHome page
W. D. Kniffin Jr, J. A. Baron, J. Barrett, J. D. Birkmeyer, and F. A. Anderson Jr
The Epidemiology of Diagnosed Pulmonary Embolism and Deep Venous Thrombosis in the Elderly
Arch Intern Med, April 25, 1994; 154(8): 861 - 866.
[Abstract] [PDF]

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 Med Care Res RevHome page
R. P. Hayes, M. T. Lundberg, and D. J. Ballard
Peer Review Organizations: Scientific Challenges in HCFA's Health Care Quality Improvement Initiative
Med Care Res Rev, April 1, 1994; 51(1): 39 - 60.


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 Med Care Res RevHome page
P. S. Romano
Can Administrative Data be Used to Compare the Quality of Health Care?
Med Care Res Rev, December 1, 1993; 50(4): 451 - 477.
[PDF]

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 JAMAHome page
W. L. Adams, Z. Yuan, J. J. Barboriak, and A. A. Rimm
Alcohol-Related Hospitalizations of Elderly People: Prevalence and Geographic Variation in the United States
JAMA, September 8, 1993; 270(10): 1222 - 1225.
[Abstract] [PDF]

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 Arch OphthalmolHome page
J. C. Javitt, A. M. McBean, S. S. Sastry, and F. DiPaolo Jr
Accuracy of Coding in Medicare Part B Claims: Cataract as a Case Study
Arch Ophthalmol, May 1, 1993; 111(5): 605 - 607.
[Abstract] [PDF]

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 Arch Intern MedHome page
S. R. Tunis, E. B. Bass, M. J. Klag, and E. P. Steinberg
Variation in Utilization of Procedures for Treatment of Peripheral Arterial Disease: A Look at Patient Characteristics
Arch Intern Med, April 26, 1993; 153(8): 991 - 998.
[Abstract] [PDF]

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 Arch OphthalmolHome page
L. P. Aiello, J. C. Javitt, and J. K. Canner
National Outcomes of Penetrating Keratoplasty: Risks of Endophthalmitis and Retinal Detachment
Arch Ophthalmol, April 1, 1993; 111(4): 509 - 513.
[Abstract] [PDF]

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 American Journal of Medical QualityHome page
G. L. Barbour
Usefulness of a Discharge Diagnosis of Sepsis in Detecting Iatrogenic Infection and Quality of Care Problems
American Journal of Medical Quality, March 1, 1993; 8(1): 2 - 5.
[Abstract] [PDF]

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 JAMAHome page
K. C. Goldberg, A. J. Hartz, S. J. Jacobsen, H. Krakauer, and A. A. Rimm
Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients
JAMA, March 18, 1992; 267(11): 1473 - 1477.
[Abstract] [PDF]


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