Relationship Between the Assignment of Icd-10 Diagnostic Codes to Inpatients and the Bpjs Claim Process at Rs X Bandung

Abstract

Accurate diagnosis coding is crucial in the BPJS Kesehatan claims process, especially for inpatients. ICD-10 codes are the basis for determining claim rates through the INA-CBGs system. This study aims to determine the relationship between accurate ICD-10 coding and BPJS claims at Hospital X, Bandung. This study used a quantitative method with a descriptive approach. A total of 97 medical records of inpatient BPJS participants were analyzed. The results showed that 60 (61.9%) cases had accurate diagnosis codes, while 37 (38.1%) cases were inaccurate. The significance value was p=0.000. The p-value indicates p<0.05, thus rejecting the null hypothesis (Ho) and accepting the alternative hypothesis (Ha). The researchers also recommend that hospitals, particularly medical records units, take steps to improve the accuracy of diagnosis coding. One possible step is to conduct regular training for coders on ICD-10 coding guidelines to improve their understanding and ability to apply codes correctly.