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The Accuracy of Myocardial Infarction Diagnosis in Medical Insurance Claims

 So Yeon Ryu  ;  Jong Ku Park  ;  Il Suh  ;  Sun Ha Jee  ;  Jong Park  ;  Chun-Bae Kim  ;  Ki Soon Kim 
 Yonsei Medical Journal, Vol.41(5) : 570-576, 2000 
Journal Title
Issue Date
Cohort Studies ; Humans ; Insurance, Health* ; Myocardial Infarction/diagnosis* ; Sentinel Surveillance
Surveillance System ; Medical Insurance Claims ; Accuracy Rate ; Myocardial Infarction
We attempted to assess the accuracy of the International Classification of Diseases (ICD) codes for myocardial infarction (MI) in medical insurance claims, and to investigate the reasons for any inaccuracy. This study was designed as a preliminary study to establish a surveillance system for cardiovascular diseases in Korea. A sample of 258 male patients who were diagnosed with MI from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 183,461 people). The registered medical record administrators were trained in the survey technique, and gathered data by investigating the medical records of the study subjects from March 1999 to May 1999. The definition of MI for this study included symptoms pursuant to the diagnostic criteria of chest pain, electrocardiogram (ECG) findings, cardiac enzyme and results of coronary angiography or nuclear scan. We asked the record administrators for the reasons of incorrectness for cases where the final diagnosis was 'not MI'. The accuracy rate of the ICD codes for MI in medical insurance claims was 76.0% (196 cases) of the study sample, and 3.9% (ten cases) of the medical records were not available due to hospital closures, non-computerization or missing information. Nineteen cases (7.4%) were classified as insufficient due to insufficient records of chest pain, ECG findings, or cardiac enzymes. The major reason of inaccuracy in the disease code for MI in medical insurance claims was 'to meet the review criteria of medical insurance benefits (45.5%)'. The department responsible for the inaccuracy was the department of inspection for medical insurance benefit of the hospitals.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Suh, Il(서일) ORCID logo https://orcid.org/0000-0002-9689-7849
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
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