Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015

Abstract

BackgroundThe ICD-10 categories of the diagnosis “perinatal asphyxia” are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context.MethodsRoutinely collected health data (encoding and financial data) of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance.ResultsThe study population included 622 cases (P20 “intrauterine hypoxia” 399, P21 “birth asphyxia” 233). By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616) = 55.84, p < 0.001, multiple R-squared = 0.312, p < 0.001) could be best explained. The classification of the severity of asphyxia could clearly be linked to the complexity of cases.ConclusionThe refined coding method provides clearly defined diagnoses groups and has the strongest effect on the distribution of costs. It improves the diagnosis accuracy of perinatal asphyxia concerning clinical practice, research and reimbursement.

Diagnosis and management of postpartum hemorrhage and intrapartum asphyxia in a quality improvement initiative using nurse-mentoring and simulation in Bihar, India

“…The WHO definition is neither predictive of outcome nor does it imply any causation. The ICD-10 categories of P20 “intrauterine hypoxia” and P21 “birth asphyxia” are classified by onset characteristics [26] but do not provide clear diagnostic criteria or threshold values and APGAR scores, fetal acidosis and fetal distress lack specificity. The terms “post-asphyxial encephalopathy” or “hypoxic ischemic encephalopathy” are also used to describe encephalopathy caused due to intrapartum injury [26, 27].…”

“…The ICD-10 categories of P20 “intrauterine hypoxia” and P21 “birth asphyxia” are classified by onset characteristics [26] but do not provide clear diagnostic criteria or threshold values and APGAR scores, fetal acidosis and fetal distress lack specificity. The terms “post-asphyxial encephalopathy” or “hypoxic ischemic encephalopathy” are also used to describe encephalopathy caused due to intrapartum injury [26, 27]. However, recent guidelines from the American Academy of Pediatrics, American College of Obstetrics and Gynecology, and International Cerebral Palsy Task Force recommend against the use of these terms unless intrapartum-related causation can be established [27].…”

Functional state of the hepatobiliary system in newborns with manifestations of hyperbilirubinemia in perinatal pathology

“…За даними літератури, на зв'язувальну здат ність альбуміну можуть впливати білково жи рове співвідношення молока матері, постна тальна гіпотрофія, а також антибактеріальна терапія дитини або матері. Окрім того, значна кількість субстратів у крові новонароджених, імовірно, конкурує з білірубіном за зв'язок з альбуміном (кальцій, неестерифіковані жирні кислоти, материнські естрогени, кортикостеро їди, антибіотики та інші речовини) [2,11]. Саме тому зниження рівня альбуміну є одним із важливих факторів, які визначають тяжкість перебігу гіпербілірубінемії, що потребує, на наш погляд, подальшого вивчення для уточ нення рекомендації ведення неонатальної жовтяниці.…”

The Classification of Causes of Historical Mortality (CCHM): A proposal of the study of death records

“…Coding diagnostic expressions of causes of death (CoDs) according to a standardized nomenclature presents major challenges [16,17]. In most cases, the person in charge of recording the CoD in the death registry is not a health staff member and is instead integrated into a certain social context [18]; in fact, this person uses expressions from popular medical knowledge [19].…”