Understanding the risks of incomplete medical coding

#5in5_Blog_BannerInformation that could affect readmission risks, reimbursement, quality assessments and more is missing from medical records according to a recent study.

MedPageToday reported on the study, conducted by researchers at Johns Hopkins University School of Medicine and published in November 2015 in the journal PLOS ONE.

The researchers compared two large databases – one based on claims data and one based on a telephone survey. Both are considered to be representative of the nation, according to The American Journal of Managed Care.

The data from the phone survey indicated far higher rates of obesity and tobacco and alcohol use than the percentages pulled from the claims data.
MedPageToday quoted the study’s authors who said the results show health care providers aren’t fully coding the risk facing many patients.

They said this underreporting can impact risk adjustments – which can affect reimbursement – and leave health systems unsure of how many high-risk patients are in their populations. It can also leave health systems without access to information that could signal a risk of readmission. And, it can taint national assessments and affect health care policy.

Incomplete coding can also be an issue when considering the quality of clinical care, according to analytic research from Optum conducted with the Anceta Collaborative. It found only about 80 percent of the group’s chronically ill patients could be identified through coding.
Those patients lacking the code for their condition may miss out on needed disease management or care coordination, which may harm the individual’s health and hinder a health system’s transition to population health management programs.

To learn more, take five minutes to read five questions and answers in the #5in5 interview Improve care quality through complete medical coding.


You can learn to use accurate coding to your advantage to better manage care. Discover what research suggests about uncoded patients – how their cases compared to other patients’ and how they utilized care. You’ll also read about how accurate coding improved outcomes for patients with diabetes.


About the Author:

Leslie Cozatt currently serves as Director of Marketing, Optum Provider – Thought Leadership and Content Strategy.

She directs the development of content that spotlights the role of data analytics in healthcare – specifically the transition to value-based care, risk management and population health management. She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M. Leslie attended the University of Minnesota and graduated from Wellington College with a BS in International Business & Communication.

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