PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Clinical Coding”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1989

Race and diagnostic related group prospective hospital payment for medical patients.

The diagnostic related group (DRG) prospective hospital payment system has been on line for five years with no major changes implemented by the federal government. Data suggest that the DRG system may be inequitable to patients of lower socioeconomic status. We studied the consumption of hospital resources by race (ie, white vs black) for hospitalized medical patients using the DRG prospective payment system. All adult medical admissions (N = 30,097) were analyzed for a three-year period at a large academic medical center using the DRG "all payor" classification scheme in effect for New York State. We found that black patients (N = 3,373) had a significantly greater (P less than .0001) mean length of hospital stay and cost per patient (adjusted for DRG weight index) compared with white patients (N = 26,724). Black patients also exposed the medical center to greater (P less than .0001) financial risk compared with white patients, as measured by outliers and losses under DRGs. Black patients (P less than .0001) had a significantly higher proportion of emergency admissions to the hospital, a greater severity of illness (as measured by total International Classification of Diseases-9-Clinical Modification codes) (P less than .0001), and higher diagnostic costs (P less than .0001) for each episode of illness. These data suggest that at our medical center black medical patients may consume more hospital resources (adjusted for DRG case mix) compared with whites. It is important that methods to modify DRG prospective hospital payment for medical diseases be considered to provide more equitable DRG reimbursement for black Americans in the future.

Black or African American↗
PubMed1986

Thoracic and cardiovascular operations in the United States, 1979 to 1984.

Using data from the National Center for Health Statistics, I conducted an in-depth analysis of numbers of thoracic and cardiovascular operations from 1979 to 1984. This is the first full 5 year period since the inception of International Classification of Diseases, Ninth Revision, Clinical Modification codes, and the findings delineate the present status of thoracic and cardiovascular surgery in the United States. During the study period there was a 34% increase in total numbers of thoracic and cardiovascular operations. Since 1970 there has been a total increase in numbers of thoracic and cardiovascular operations of 150%. In 1983 thoracic and cardiovascular surgeons performed 191,000 coronary artery bypasses. This operation is the most common thoracic and cardiovascular procedure and has become the nineteenth most common operation now performed in this country. Pacemaker placement, revision, or removal (190,000) is the second most common thoracic and cardiovascular operation and the country's twentieth. The twenty most common thoracic and cardiovascular operations constitute 87% of all thoracic and cardiovascular operations. In 1983 thoracic and cardiovascular operations represented 3% of all operations completed in this country. These figures represent the dynamics of thoracic and cardiovascular surgical practice. They demonstrate that numbers of thoracic and cardiovascular operations have consistently increased over the past 15 years. However, this increase is almost entirely due to the advent of coronary artery bypass.

Cardiac Surgical Procedures↗
PubMed1987

Serial determinations of the amino-terminal peptide of type III procollagen in severe chronic active hepatitis.

To evaluate the diagnostic significance of the amino-terminal propeptide of procollagen type III (P-III-P) in monitoring chronic liver disease, serum P-III-P concentrations were measured in 46 patients with severe chronic active hepatitis (CAH) at entry and at remission during a therapeutic clinical trial. Coded sera were analyzed for P-III-P concentrations by both a standard radioimmunoassay and a recently developed and potentially more precise radioimmunoassay that uses Fab fragments rather than intact antibodies for binding antigen. As compared with conditions in 22 normal controls, P-III-P concentrations were elevated in 98% and 72% of patients with CAH by use of the standard and Fab radioimmunoassays, respectively. With treatment, P-III-P levels fell at remission to levels that were not significantly different from control values, as measured by both assays. The Fab radioimmunoassay, either alone or combined with the standard radioimmunoassay, provided no advantage over the standard radioimmunoassay alone. Serum P-III-P levels, as measured by either assay, correlated poorly or not at all with standard liver function tests and with histologic grade of disease. These data suggest that P-III-P serum levels are abnormal in severe CAH but normalize when remission of disease has been achieved. Consequently, serum P-III-P levels may be a diagnostic aid in the sequential evaluation of patients with severe CAH requiring treatment, and this test deserves further investigation. In this regard, the standard P-III-P assay has greater diagnostic accuracy than the Fab assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Comparative study of the biotype, hemolysin-producing capability and antibiogram of the aquatic and the clinical strains of Aeromonas hydrophila.

One hundred and seventy-two Aeromonas hydrophila strains were isolated from aquatic hosts including fish, turtle, frogs, shellfish and water itself. The aquatic organisms were compared with 45 clinical strains with regard to biotype, hemolysin, and antibiogram. The carrier rate of A. hydrophila in the aquatic environment was 61.7%. Of the aquatic strains 51% were hemolysin producers, equivalent to a capability for producing enterotoxin. The hemolysin-producing capability of aquatic strains was not significantly different from that of the clinical strains. The main code numbers or biotypes of aquatic strains were 3265 (29.4%), 3065 (17.5%), 7065 (9.6%), 7265, 3225 (each 8.5%). The main code number or biotypes of clinical strains were 3265 (36.1%), 3065 (9.8%), 7261 (6.6%), 2265, 3261 and 6241 (each 4.9%). Analysis of the antibiotic susceptibility pattern of both aquatic and clinical A. hydrophila strains using the microbroth dilution method showed that there is no significant difference in antibiotic susceptibility. Most aquatic and clinical strains were highly susceptible to tobramycin, gentamicin, amikacin, cefuroxime, piperacillin, cefotaxime and cefoperazone. Most strains of aquatic A. hydrophila were highly susceptible to cefamandole and chloramphenicol; however, clinical strains were only moderately susceptible to the same drugs. Most aquatic and clinical strains were highly resistant to ampicillin, and moderately resistant to sulbenicillin. Clinical strains were moderately resistant to cephapirin; however, aquatic strains were moderately susceptible to cephapirin. Based on the above findings, we may considered aquatic environment be, at least partially, the source of clinical strains. Furthermore, biotypes of aquatic A. hydrophila do not correspond to antibiogram or hemolysin-producing patterns.

Aeromonas↗
PubMed1990

Isolation and identification of the gene of cholesterol oxidase from Brevibacterium sterolicum ATCC 21387, a widely used enzyme in clinical analysis.

The gene coding cholesterol oxidase (CHOD) from Brevibacterium sterolicum, which is widely used in clinical analysis, has been selected from pUC19-based gene bank in E. coli MM294 by colony-hybridization using synthetic DNA as probe. The gene was identified to encode the protein having the same amino acid sequence as that determined from amino-acid sequence analysis. The expression of the CHOD gene in E. coli was not observed, probably due to the transcription failure. Attempts are being made to express it in various hosts including Streptomyces lividans, Corynebacterium glutamicum, and B. sterolicum itself.

Amino Acid Sequence↗
PubMed1985

[Color-coded 2-dimensional Doppler echocardiography. Initial clinical experiences].

A new technology based on the Doppler principle for ultrasound has recently enabled the real-time visualization of cardiac blood flow by superposition of coloured flow information onto a two-dimensional echocardiogram. This study presents typical flow patterns in standard echocardiographic views, obtained from normal subjects and patients with acquired valvular or congenital heart diseases. Diagnostic possibilities and limitations of colour-coded Doppler echocardiography are discussed.

Adult↗
PubMedDate not supplied

Improved diagnostics: clinical evaluation of a color-coded, polymeric periodontal probe.

The objective of this study was to compare the accuracy, reproducibility and patient comfort of a newly designed, color-coded, polymeric periodontal probe to a traditional, color-coded metal probe. Twenty-four adult subjects with varying degrees of periodontal disease (from slight to severe) reported for two visits, one week apart. A randomization schedule for probe use was adopted over the two visits so that the gingival crevices in two quadrants were probed with the same probe (metal or polymeric) providing reproducibility information for each probe, while the other two quadrants were probed first with one probe then the other for comparison data yielding information on accuracy. A bleeding index was obtained using the same schedule. Clinical scoring was performed by the same examiner. After probing each quadrant, subjects rated discomfort using a visual analog scale (VAS). Results showed no significant difference in depth readings greater than 2 mm between the polymeric and metal probes (3.41 +/- 0.37 mm vs. 3.38 +/- 0.32 mm, p = 0.55). Significantly less discomfort (assessed by VAS) was recorded by patients after polymeric probe use (3.70 +/- 2.40 cm vs. 4.44 +/- 2.49 cm, p = 0.015). The bleeding index indicated significantly less bleeding with the polymeric probe (0.80 +/- 0.56 vs. 1.24 +/- 0.65, p = 0.0001). Both the polymeric and metal probes were found to produce highly reproducible results in all measures across visits.

Adult↗
PubMedDate not supplied

Capturing the semantic relationship between clinical terms with current MeSH bibliographic coding.

This paper compares bibliographic retrieval using current MeSH (Medical Subject Headings) to bibliographic retrieval using explicitly coded semantic relationships between index terms. In a previous study, ten lists of abstracts, each list containing 20-40 papers discussing a specific pair of terms, were analyzed to identify the specific relationship(s) between those terms discussed in each paper. In the present study, we analyze how well current MeSH coding using topical subheadings and check tags, can selectively retrieve those papers discussing each semantic relationship.

Abstracting and Indexing↗
PubMed1990

Rapid diagnosis of tuberculous meningitis by frequency-pulsed electron-capture gas-liquid chromatography detection of carboxylic acids in cerebrospinal fluid.

The frequency-pulsed electron-capture gas-liquid chromatography technique described previously by Brooks et al. was modified and applied to the studies of coded and routine clinical specimens. Uncentrifuged cerebrospinal fluid (2 ml) was extracted under acidic conditions, derivatized, and analyzed by frequency-pulsed electron-capture gas-liquid chromatography on large-bore fused silica polar and nonpolar capillary columns. The frequency-pulsed electron-capture gas-liquid chromatography profile of carboxylic acids (C2 through C22) along with identification of tuberculostearic acid, established by retention time comparison of derivatized tuberculostearic acid and derivatized sample extract, strongly suggests the presence of Mycobacterium tuberculosis in patients with lymphocytic meningitis. Results from 41 coded cases and 75 clinical cases showed that the frequency-pulsed electron-capture gas-liquid chromatography test had a specificity of 91% and a sensitivity of 95%.

Carboxylic Acids↗
PubMed2026

Can ChatGPT Replace Human Clinical Coders? A Comparative Study in Otology Billing.

OBJECTIVE: Evaluate the utility of the large language model (LLM), ChatGPT, for the analysis of operative notes and the generation of Current Procedural Terminology (CPT) codes in comparison to human clinical coders. STUDY DESIGN: CPT billing codes assigned by ChatGPT were compared to existing billing data. Otology practice within a tertiary academic center. METHODS: About 191 operative notes from a single surgeon (9/2022-10/2023) were analyzed. ChatGPT-3.5 and 4 models were prompted for CPT codes based on operative notes. Assessment included determining exact and partial match rates, sensitivity and specificity for targeted procedures, and work Relative Value Units (wRVU) differences between ChatGPT-generated and human-assigned codes. RESULTS: ChatGPT-3.5 achieved exact matches in 22% of cases and partial matches in 32%, while ChatGPT-4 achieved 14% exact and 33% partial matches. When cochlear implantation (CI) was excluded, performance dropped significantly. For CI, ChatGPT-3.5 demonstrated a sensitivity of 94% and specificity of 90%, while ChatGPT-4 showed a sensitivity of 96% and specificity of 92%. In contrast, performance on cartilage grafting was poor, with sensitivities of 4.2% for ChatGPT-3.5 and 0% for ChatGPT-4. ChatGPT-3.5 and 4 showed moderate CPT code matching accuracy among themselves, with slight agreement to human coders. Both models tended to underbill for wRVUs compared to human coders, with significant differences in the values generated. CONCLUSION: This study assessed ChatGPT's effectiveness in automating CPT code assignment for otologic surgeries. While the models achieved high sensitivity values for assigning codes related to cochlear implantation, both models struggled with complex cases, failed to apply modifiers, and often assigned fewer wRVUs. The findings highlight ChatGPT's potential in medical billing but indicate a need for further refinement.

Humans↗
PubMed1988

Confirmation of the utility of fine needle aspiration biopsy of the renal allograft.

Allograft immunobiologic theory would predict that analysis of immunocompetent cells infiltrating the renal transplant would be most instructive. Recently a new aspiration biopsy technique has been developed to permit such analysis in patients which can be safely and repetitively performed. The clinical utility of such a technique has been tested utilizing a randomized prospective trial in which an aspirate was obtained every other day from the third post-operative day until discharge. Analysis included examination of adequacy criteria and the capacity of pathologic diagnosis to corroborate clinical diagnosis from coded specimens. Ninety-six aspirates from 21 consenting transplant recipients were obtained and analyzed. In 94 instances a clinical diagnosis could be made; 80 aspirates fulfilled adequacy criteria. We found the technique to be highly sensitive (greater than or equal to 90%) and highly specific (greater than or equal to 90%) for the clinical diagnoses of acute allograft rejection, post-operative acute renal failure, cyclosporine toxicity, and normal function. We conclude that the fine needle aspiration technique is an important adjunct to analysis of clinical renal transplantation and offers a major advantage to the clinical scholar in understanding transplant biology.

Acute Kidney Injury↗
PubMed1978

Sampling of speech pathology treatment activities: an evaluation of momentary and interval sampling procedures.

Videotaped samples of aphasia treatment sessions were coded, using the Clinical Interaction Analysis System (CIAS), a 39-category system for recording the events that occur in clinician-patient interactions during aphasia treatment sessions. These coded records were then sampled according to various schedules and procedures and the fidelity with which each sampling schedule and procedure represented the content of the entire treatment record was evaluated. In addition, trained observers coded videotaped samples of treatment, using the CIAS with a number of sampling schedules and procedures. The fidelity with which these observers' records represented the content of the treatment sessions sampled was then evaluated. The results of the analysis indicated that momentary sampling at intervals distributed throughout the session generates more accurate records of session content than single longer samples taken from the session, unless those single samples comprise a major part of the session, and that sampling representativeness remains high even when only one event in ten is sampled, if sampled events are uniformly distributed throughout the session.

Aphasia↗
PubMed1990

DSM-III-R diagnosis and code types of the diagnostic inventory of personality and symptoms in an adolescent clinical population.

The relationships of high-point code types of the Diagnostic Inventory of Personality and Symptoms (DIPS) to the Diagnostic and statistical manual III-R (DSM-III-R; American Psychiatric Association, 1987) were explored for adolescent patients (N = 263). Twelve DIPS code types that relate code types to Axis I diagnoses are prepared. The three DIPS personality disorder cluster scales and the eight combinations thereof are presented as well. Six of the personality disorder cluster scale code types that relate to DSM-III-R Axis II categories are identified. Finally, a narrative summation of each of the code types is given.

Adolescent↗
PubMed1992

Short-term memory and verbal learning with auditory phonological coding defect: a neuropsychological case study.

A patient is described with a rarely reported linguistic syndrome: he could repeat words but not nonwords. The patient produced semantic paraphasias in repetition and could read both words and nonwords flawlessly. His basic difficulties were localized in auditory phonological coding, identifying a clinical picture called "phonemic deafness." Short-term memory and verbal learning results suggested that a standard, selective short-term memory defect can be induced by auditory phonological coding deficits as well as by "pure" short-term memory capacity limitation and other phonological deficits. Findings also provided evidence that lexical-semantic code can allow normal verbal learning.

Adult↗
PubMed1989

Morbidity coding in general practice.

If research is to be of any use the phenomena being studied must be clearly defined. Almost 30 years ago the difficulty of classifying primary care problems using the International Classification of Diseases (ICD-8) was demonstrated. This led to the development of the International Classification of Health Problems in Primary Care-2-Defined which is based on ICD-9. Despite the work that has gone into the development of ICHPPC-2-Defined, relatively little work has been undertaken to assess the validity and reliability of its use. This paper describes the results of such a study conducted as a preliminary to the use of ICHPPC-2-Defined in a study of consulting patterns in general practice. The participating general practitioners were trained in the use of ICHPPC-2-Defined and then coded problems which they identified in a set of clinical vignettes. Following the coding exercise, a review session was held in which difficulties and errors in the use of ICHPPC-2-Defined were discussed. Subsequently, the general practitioners were required to code two more sets of vignettes, which included some problems repeated from the preceding sets. Comparisons were then made of changes in the validity and reliability of coding from one round to the next. The results of the study suggest that the reliability and validity of morbidity data collected using ICHPPC-2-Defined can be increased by training sessions for the coders which focus on the main sources of error in the use of ICHPPC-2-Defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1989

Accuracy in clinically evaluating pigmented lesions.

OBJECTIVE: To determine the ability of three doctors experienced in managing melanocytic lesions to diagnose correctly melanoma, dysplastic naevi, and various benign pigmented lesions. DESIGN: Independent clinical evaluation and histopathological assessment. SETTING: Pigmented lesion clinic, which patients attend without an appointment for early diagnosis of melanoma. PATIENTS: 86 Patients with lesions that were judged to be benign by at least one of the three doctors. INTERVENTIONS: The lesions were excised under local anaesthesia and sent for histopathological examination in coded bottles without clinical details. MAIN OUTCOME MEASURE: Comparison of clinical with histopathological diagnosis for each lesion. RESULTS: A total of 120 lesions were evaluated by at least two of the three doctors. The histopathological diagnoses were made by the same pathologist. The overall sensitivity (diagnostic accuracy) for the three doctors for all types of lesion was 50%. Of the 39 dysplastic naevi, only 19 were identified correctly by all observers, and a further 24 banal lesions were wrongly diagnosed as dysplastic by at least one doctor. Particular difficulty was experienced with small (less than 5 mm), flat lesions, which can be banal or potentially malignant. CONCLUSIONS: Critical diagnosis and management decisions concerning pigmented lesions should always be based on a combination of clinical and histopathological assessments and the history of the patient.

Diagnosis, Differential↗