Association between Pregnancy Postterm Diagnosis Code Accuracy and National Health Insurance Reimbursement Regularity

Eni Nur Rahmawati1), Maya Milenia Atlantic2)


1)Masters Program in Public Health, Universitas Sebelas Maret

2)Diploma III of Medical Record and Health Information, Universitas Duta Bangsa, Surakarta



Background: Accurate clinical coding is important to ensure that the range of clinical activity being undertaken is reliably captured to further guide resource allocation in proportion to demand. This study aimed to examine the association between pregnancy post-term diagnosis code accuracy and national health insurance reimbursement regularity.

Subjects and Method: This was a cross-sectional study carried out at dr. Soeroto regional hospital, Ngawi, East Java, in April 2020. 89 out of 823 medical records were selected by simple random sampling. The dependent variable was regularity of national health insurance reimbursement. The independent variable was pregnancy postterm diagnosis code accuracy. The data were collected by observation and checklist. The data were analyzed by Chi square.

Results: Accuracy of pregnancy postterm diagnosis code was 27%. Inaccuracy (73%) was caused by inappropriate code with the gestational age. Health insurance reimbursement regularity was 26%. Irregularity health insurance reimbursement (74%) was caused by high inaccuracy of pregnancy postterm diagnosis code. Health insurance reimbursement irregularity increased with inaccuracy of pregnancy postterm diagnosis code (OR= 11.87; 95% CI= 3.91 to 36.00; p<0.001).

Conclusion: Accuracy of pregnancy postterm diagnosis code is positively associated with national health insurance reimbursement regularity.

Keywords: code accuracy, diagnosis, pregnancy post-term, national health insurance

Correspondence: Eni Nur Rahmawati. Masters Program in Public Health. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: 085743748528.


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