Rosana Dwiyanti Putri
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The Accuracy of ICD-10 Codes for Clinical Diagnosis and Supporting Examinations of Hypertension Cases in Inpatient Care at Hospital Agustina; Meilany, lilik; Muh Erwin Rosyadi; Rosana Dwiyanti Putri; Ruslan Agussalim; Jeny Rezkysadin Ilyas
Comprehensive Health Care Vol. 9 No. 2 (2025): Comprehensive Health Care
Publisher : Lembaga Penelitian dan Pengabdian Masyarakat, Stikes Panrita Husada Bulukumba

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37362/chc.v9i2.613

Abstract

Background: Accurate diagnosis coding is essential to support processes such as the preparation of statistical reports, health insurance claims to BPJS, and data-based decision-making. A preliminary study at RSUD X Makassar in the first quarter of 2025 found 243 electronic medical records of inpatients diagnosed with hypertension with diabetes mellitus complications, of which 20 records contained incorrect codes. Objective: To determine the relationship between clinical diagnosis and supporting examinations with the accuracy of ICD-10 codes in hypertension cases among inpatients at RSUD X Makassar. Methods: This study employed a cross-sectional design with a quantitative approach. The population consisted of inpatient medical records from the first quarter, with a sample of 71 medical records of hypertension cases selected using random sampling. Results: Based on hypothesis testing, two variables were analyzed: clinical diagnosis and ICD-10 code accuracy. The significance value (p-value) was 0.184. Since the significance value of 0.184 > 0.05, the next variable tested was the completeness of supporting examinations and code accuracy, which yielded a significance value of 0.452 > 0.05. Further Pearson correlation testing revealed that the strength of the relationship between clinical diagnosis and code accuracy had a correlation coefficient of r = 0.158 with a significance value of p = 0.189 (p > 0.05). Meanwhile, the relationship between completeness of examinations and code accuracy showed a correlation coefficient of r = 0.089 with a significance value of p = 0.459 (p > 0.05), indicating a very weak correlation. Conclusion: Both variables demonstrated no significant relationship, suggesting that other factors may be more dominant. The experience and training of coders may have a greater influence than the completeness of medical records. Moreover, the implementation of health information technology could further enhance coding accuracy. Keyword: Code Accuracy, Clinical Diagnosis, Supporting Investigation
Implementation of a Medical Coding Mentorship Program to Reduce BPJS Health Insurance Pending Claims at Sandi Karsa Hospital, Makassar Agustina; Lilik Meilany; Asriyanti; Rosana Dwiyanti Putri
Abdimas Polsaka Vol. 5 No. 1 (2026): Abdimas Polsaka: Jurnal Pengabdian Masyarakat
Publisher : LPPM Politeknik Sandi Karsa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35816/abdimaspolsaka.v5i1.256

Abstract

Background: In Indonesia’s National Health Insurance (JKN) system, the accuracy of medical coding plays a critical role in determining claim approval and reimbursement through the Indonesia Case Base Groups (INA-CBGs) payment mechanism. Inaccurate coding of diagnoses and procedures often results in pending BPJS Health claims, leading to delayed payments and increased administrative burden for hospitals. This community service activity aimed to implement and evaluate a mentoring program designed to improve medical coding practices and reduce pending BPJS Health claims at Sandi Karsa Hospital, Makassar. Methods: The program was conducted from August to October 2025 using a participatory and problem-solving approach. The activities included initial assessment of pending claims, theoretical training on ICD-10 and ICD-9-CM coding principles, case-based simulations using actual medical records, direct on-site mentoring during coding processes, and the development of a Standard Operating Procedure (SOP) for medical coding. Program evaluation was performed by comparing the number of pending claims related to coding errors before and after the intervention and by observing improvements in coding practices. Results: Prior to the intervention, 85 cases of pending claims were identified as being caused by coding rule errors. After the mentoring program was implemented, the number decreased to 34 cases, representing a reduction of approximately 60%. In addition, qualitative improvements were observed in the consistency of determining principal and secondary diagnoses, the accuracy of ICD-10 and ICD-9-CM code selection, and the overall quality of claim documentation. Conclusion: The mentoring-based intervention effectively improved medical coding accuracy and reduced BPJS pending claims at the hospital. Continuous training, regular coding audits, and the implementation of standardized coding procedures are recommended to sustain these improvements and support more efficient hospital claim management