Physician review improves hospital DRG reimbursement in injury

J Trauma. 1992 Sep;33(3):370-3; discussion 373-4. doi: 10.1097/00005373-199209000-00006.

Abstract

This was a prospective study of all DRG reimbursed trauma patients discharged during an 11-month period. Initial DRGs were assigned by hospital coding specialists (HCS). A surgeon (SURG) subsequently reviewed each chart and assigned DRGs to maximize reimbursement. The data for 244 patients were: age = 36.5 years, Trauma Score (TS) = 13.8, Injury Severity Score (ISS) = 16.9, and length of stay (LOS) = 10.3 days. Total charges for the 244 patients were $4,261,208 with an initial HCS projected reimbursement of $1,687,963. The SURG review resulted in a total projected reimbursement of $1,956,476, an increase of $268,513 in revenue (p less than 0.001). Charges correlated strongly with LOS and ISS. The HCS-coded and SURG-coded reimbursements also correlated positively with LOS and ISS, but to a lesser extent. The SURG review of DRG assignment improved hospital reimbursement for the injured patients. However, this reimbursement fell well below hospital billings.

MeSH terms

  • Abstracting and Indexing / standards*
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Craniocerebral Trauma / diagnosis
  • Craniocerebral Trauma / economics
  • Diagnosis-Related Groups*
  • Fees and Charges / statistics & numerical data
  • Female
  • General Surgery*
  • Hospitals, Teaching
  • Hospitals, Urban
  • Humans
  • Injury Severity Score
  • Insurance, Health / classification
  • Insurance, Health / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Multiple Trauma / diagnosis*
  • Multiple Trauma / economics
  • Multiple Trauma / mortality
  • Ohio / epidemiology
  • Physicians / statistics & numerical data*
  • Prospective Studies
  • Reimbursement Mechanisms / standards*
  • Reimbursement Mechanisms / statistics & numerical data
  • Trauma Severity Indices
  • Utilization Review / methods
  • Utilization Review / standards*