Coding and Casemix Audit include:
Evaluating the adequacy of clinical documentation
Looking for missed diagnoses
Checking the accuracy of the ICD-10-AM codes assigned and consequent appropriateness of the DRG assigned
Ensuring that associated patient data elements such as, the length of stay, separation mode, continuous mechanical ventilation (CMV) hours etc are correct
Auditing Outcomes
Need for better discharge planning; care co-ordination
Timely allied health assessment and intervention
Identification of episodes that could be managed at another facility
Identification of conditions that could be managed at another time
Barriers to admission on day of surgery
Timeliness of medical imaging
Targeting Records for Audit
Target at least the following:
Records where LOS is greater than the State Average LOS, a move to an adjacent DRG
Multiday LOS and principal diagnosis is a symptom
Calculation of CMV hours
Selection of principal diagnosis in trauma episodes
Pathology or imaging suggest a diagnosis but it is not documented and/or coded
Compliance with DH Admission Policy
Attachment:- Sc.zip