Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?

Abstract

Bias against coding of chronic or comorbid conditions on the computerized discharge abstracts of patients who die best explains these results. Efforts to improve diagnosis coding completeness solely by increasing the number of available coding spaces may not succeed.

Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

“…Similarly, our complication rate may reflect the referral practice of the senior author (EGM), and the findings may not be extrapolated accurately to other surgical practices. However, our study involved a direct chart review that allowed us to detect all reported complications on patients; the literature shows that this method is more accurate than relying solely on hospital discharge data and billing procedure codes [11,16,21,22,34,45]. Although the current literature lacks a uniform classification of postoperative complications in total joint arthroplasties, the events defined as postoperative complications in our study are mostly consistent with those defined in previous studies [6,13,20,40,44].…”

Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses

“…This explanation may also underlie the lower mortality in some studies for patients with secondary diagnoses of hypertension and diabetes. 16,17 Indeed, in the current analysis, patients with psychiatric comorbidity from inpatient codes had the lowest predicted mortality (Table 2)-supporting the hypothesis that secondary inpatient codes may serve as a marker for lower severity. Moreover, some prior studies have also demonstrated that patients with psychiatric comorbidity identified by secondary inpatient codes had lower mean predicted risk of mortality.…”

Lumbar spine surgery and mortality among Medicare beneficiaries, 1986.

“…The paradoxical protective effect of hypertension observed in this study has been reported previously, but without a definitive explanation. 33 In summary, this study of the large HCFA claims files for 1986 helps define age and gender demographics related to low back pain and outcome following lumbar spine surgery in all elderly Medicare beneficiaries in the United States. In 34418 elderly patients who underwent lumbar spine surgery, male gender was associated with higher in-hospital and 1-year age-adjusted mortality than that observed in women.…”