Analysis of the Accuracy of Diagnosis Coding (Chapters XIX–XX) and Procedure Coding in the Emergency Department of R.T. Notopuro Regional General Hospital, Sidoarjo
Analisis Ketepatan Kodefikasi Diagnosis Bab XIX-XX dan Tindakan di IGD RSUD R.T. Notopuro Sidoarjo
DOI:
https://doi.org/10.21070/ups.11754Keywords:
Analysis of the Accuracy of Diagnosis, Coding (Chapters XIX–XX), and Procedure Coding, in the Emergency Department, R.T. Notopuro Regional General Hospital, SidoarjoAbstract
Accurate diagnosis and procedure coding are essential for BPJS Health claims because coding information determines the INA-CBGs grouping. This study aimed to analyze the accuracy of Chapter XIX-XX diagnosis and procedure coding in the Emergency Department (IGD) of RSUD R.T. Notopuro Sidoarjo. A descriptive quantitative design was used. The study was conducted at the Claim Guarantee Installation in June 2026 using 50 BPJS Health claim records involving injury, poisoning, and external cause cases selected through quota sampling. Data were collected through medical record observation, structured interviews with IGD doctors, and review of BPJS claim verification documents. Results showed that 24 records (48%) had accurate diagnosis coding, while 26 (52%) were inaccurate. Problems included insufficient fourth-character specificity, incomplete fifth-character coding, and missing external cause codes. Procedure coding was more accurate, with 36 records (72%) accurate and 14 (28%) inaccurate. Improved documentation, coding competency, audits, and interprofessional coordination are recommended.
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