Cesarean deliveries difficult to code into diagnostic groups

The wide variation in coding practices for cesarean delivery-related hospital admissions underscores difficulties in the coding and the personal judgments that coders need to make when assessing cesareans, according to a study in the August issue of Obstetrics & Gynecology.

Nancy Chescheir, MD, of the University of North Carolina in Chapel Hill, and Laura Meints, MD, of Vanderbilt University Medical Center in Nashville, TN, conducted a study of hospital coders from 11 institutions, who assigned nine hypothetical cesarean delivery patients to a diagnosis-related group, as well as assigning International Classification of Diseases, 9th Revision codes and Physicians’ Current Procedural Terminology Coding System codes.

Consensus in diagnosis-related coding occurred in only two-thirds of the cases, and there was also wide variation in the ICD-9 codes used, the researchers found. Only 16.3% of the Physicians’ Current Procedural Terminology Coding System codes were used in the same case by all coders, and 28.6% of the codes were used by a single institution, the investigators discovered.

“The variability noted reflects the difficulty of the coding process and judgments that need to be made by the coders in assigning the codes,” the authors write. “Secondary uses of such codes--such as resource allocation, research, and quality surveillance--should also be used with caution, given the high degree of variation in coding practices demonstrated in both this study and other studies.”

Chescheir N, Meints L. Prospective study of coding practices for cesarean deliveries.

Obstet Gynecol.

2009;114:217-233.