Who is Coding in Hospitals? Results of a Survey on the Implementation of DRG Coding in Hospitals of North Rhine-Westphalia

Introduction:. Doctors demand more time for patient care. Since the implementation of the German DRG-System for inpatient care the documentation/coding increased in relevance. Hence there is an ongoing discussion about whether doctors or specially trained coders should take care of the coding process. Method: The DRG-Research-Group of the University Hospital Munster conducted a survey on differential charging of the current situation regarding the implementation of coding by medical personnel or by coders within the member hospitals of the Krankenhauszweckverband Koln, Bonn und Region. For this purpose a self-constructed, three-sided questionnaire with 14 questions was used and evaluated statistically. Results: 157 hospitals were contacted. The response rate was 45%. The sample included 67 hospitals (five university hospitals, three maximum care, 14 tertiary care hospitals and 45 general hospitals). 75% of the hospitals worked with coders to relieve the doctors and to increase the coding quality. Coders encode mainly diagnoses and non-interventional and non-surgical procedure codes. The university hospitals have an average of 14.5 full-time positions for coders, maximum care about 7.8, 4.2 in tertiary care hospitals and 2.8 in general hospitals. Based on the average numbers of in-patients coders in general hospitals have to work on significantly more cases (3980/coder/year) than in university hospitals and hospitals of maximum care (3247/coder/year). 59% of hospitals not employing coders wanted to continue in the future. 24% of hospitals reported to plan to switch to coders within one year. Conclusion: Coders have become widely accepted in particular in hospitals with higher levels of care. This leads to a relief of (especially younger) doctors in parts of the DRG coding (diagnoses,