Firearm Intent Discrepancies Found in Revenue Cycle Discharge Data

A recent study found a "predominant misclassification problem" with firearm injury intent in hospital discharge data.

Coded firearm data is playing a larger role for hospitals and health systems as many are placing an emphasis on firearm education and social determinants of health capture.

Unfortunately, a retrospective medical record review recently published in JAMA Network Open is showing a gap in this data.

The study found that 28% of intentional firearm injuries resulting in emergency department admissions were inaccurately coded as accidents.

An expert panel recently characterized this coding problem as a glaring gap in the US firearms data infrastructure, the study said.

To better understand the nature of this problem, researchers reviewed electronic health records for firearm injury encounters at three level I trauma centers and compared researcher-adjudicated intent for each incident with the intent indicated by the diagnosis code assigned by the revenue cycle.

They reviewed 1,227 medical records for patients who presented to the emergency department with a firearm injury of any severity between October 1, 2015, and December 31, 2019.

Researchers determined that 837 (68.2%) reviewed cases were intentional assaults, but of these assaults, 234 (28%) were coded as unintentional injuries in hospital discharge data.

Misclassification was substantial even for patient cases described explicitly as assaults in clinical notes, the study found.

Firearm injury intent coding would likely improve if hospital records included unambiguous and explicit intent-related language, and if there were more coding instructions linked to assault, as opposed to “accident,” according to the researchers.

Making sure your revenue cycle is capturing this information correctly is the first step in ensuring an accurate firearms data infrastructure.