Coding of significant comorbidities and complications for stroke in rehabilitation

I see nothing here that accurately defines what causes death after stroke. Stroke is not an accurate enough reason for dying. We need to have an accurate description of the size and location of the brain death area if we are ever to correlate and find interventions that would stop or lessen that brain death area. Old age is no longer allowed on death certificates, stroke should not be allowed either. 
http://journals.sagepub.com/doi/abs/10.1177/1833358317699841

Joanne Murray, PhD, CPSP, Rhonda Pfeiffer, GradDip(AppInfoSystems), ADip(MRA), Ingrid Scholten, Ed.D

First Published March 30, 2017

Abstract

Background

Comorbidities and complications of stroke have implications for level of care and hospital resources. It is critical, therefore, that hospital morbidity data accurately reflect the prevalence of these additional diagnoses.

Objective

This study aimed to measure and describe the concordance between stroke clinicians/researchers and medical record coders when recording stroke and related diagnoses.

Method

Diagnoses recorded prospectively, according to defined criteria by a clinical research team, were compared with the coding of stroke comorbidities and complications as per the Australian Coding Standards (ACS) from the separations of 100 inpatients from three rehabilitation facilities in South Australia. Percentage agreement, kappa coefficient, sensitivity and specificity values were calculated.

Results

Kappa coefficients for agreement of prospective diagnoses with coding ranged from 0.08 to 0.819. The diagnoses with the highest agreement were stroke, aspiration pneumonia (nil cases), aphasia and dysphagia. The diagnoses with the lowest agreement were apraxia, cognitive impairment, constipation and dehydration.

Conclusion

Not all stroke comorbidities are represented accurately in hospital morbidity datasets. Education of stroke clinicians about the current ACS may clarify expectations about medical record documentation for coding purposes which in turn may result in more accurate morbidity data and therefore costings for the rehabilitation sector.