DRG Creep

Surgical site infection in hand surgery

“…Second, as in all claims-based studies, coding misclassification and incompleteness can occur. Furthermore, coding accuracy could be influenced by financial incentives and fear or retribution [28,29]. Third, patients with SSIs who made postoperative visits to physician offices were not captured.…”

Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?

“…In order to promote a shift from what is to what ought to be, normative capitations should arguably be built upon direct measures of health status [2] rather than, as hitherto, incorporating additional morbidity variables into models of individual-and/or area-level health service utilisation data in an attempt to isolate 'legitimate' risk adjusters that can then be used to estimate underlying health care resource needs [14,35,36]. Yet notwithstanding the limitations of such empirical approaches, there has been little practical progress developing more explicitly normative approaches to resource allocation.…”

“…Diagnosis-based risk adjustment systems may encourage clinicians to seek out complications or co-morbidities associated with the diagnosis or treatment, as the most complicated cases result in higher payments. Hospitals and/or clinicians may also deliberately miscode and misclassify patient data in order to attract higher expenditure weightings [35,36]. Additional monitoring and/or penalty systems are required to eliminate such practices.…”

Use and Utility of Administrative Health Data for Stroke Research and Surveillance

“…Code creep, a term that has been coined since the 1980s refers to the situations when codes leading to higher reimbursement will be preferred. 28 An American study showed that 61% of the coding discrepancies financially favored the hospitals. 29 This led the government to require physicians to attest to the accuracy of diagnostic codes, a decision later eliminated in 1995.…”