The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91. The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

This study mainly aims to identify the direct cost and economic burden of hypoglycemia for patients with type II diabetes mellitus in Malaysia. A cross-sectional study explored the cost incurred for hypoglycemia among patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC). The study covered patients aged 20–79 years hospitalized with a primary diagnosis of ICD-10 hypoglycemia and discharged between January 2010 and September 2015 according to the casemix database. A costing analysis was done through a step-down approach from the perspective of health providers. Cost data were collected for three levels of cost centers with the help of a hospital-costing template. The costing data from UKMMC were used to estimate the national burden of hypoglycemia among type II diabetics for the whole country. Of 244 diabetes patients admitted primarily for hypoglycemia to UKMMC, 52% were female and 88% were over 50 years old. The cost increased with severity. Managing a hypoglycemic case requires five days (median) of inpatient stay on average, with a range of 2–26 days, and costs RM 8,949 (USD 2,289). Of the total cost, 30% related to ward (final cost center), 16% to ICU, and 15% to pharmacy (secondary-level cost center) services. Considering that 3.2% of all admissions were hypoglycemia related, the total annual cost of hypoglycemia care for adult diabetics in Malaysia is estimated at RM 117.4 (USD 30.0) million, which translates to 0.5% of the Ministry of Health budget. Hypoglycemia imposes a substantial economic impact even without the direct and indirect cost incurred by patients and other cost of complications. Diabetic management needs to include proper diabetic care and health education to reduce episodes of hypoglycemia.

Objective: The main aim of this study is to identify the direct cost and economic burden of hypoglycaemia among patients with Type II diabetes mellitus in Malaysia. Methods: The incurred cost for hypoglycaemia among patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC) was explored from a cross sectional study. 20-79 year patients discharged between Jan 2010 to Sept 2015 and having an ICD-10 code of hypoglycaemia as a primary diagnosis in the casemix database were included in the study. Costing analysis from the perspective of health providers was completed using step-down approach. Data related to hospital cost were collected using hospital-costing template, based on three levels of cost centres. The costing data from UKMMC was used to estimate the national burden of hypoglycaemia among type II diabetics for the whole country. Results: Of 244 diabetes patients admitted primarily for hypoglycaemia to UKMMC, 52% were female and 88% were over 50 years old. The cost increased with severity. Managing a hypoglycaemic case requires 5 days (median) of inpatient stay with a range of 2-26 days; and costs RM 9,083 (USD 2,323). 30% of the cost came from the ward services cost (final cost centre), 16% of the cost came from ICU services and 15% from pharmacy services(secondarylevel cost centres). Based on the prevalence of hypoglycaemia-related admissions of 3.2%, the total cost of care for hypoglycaemia among adult diabetes in Malaysia is estimated to be RM 117.4 (USD 30.0) million, which is translated as 0.5% of Ministry of Health budget. Conclusion: Hypoglycaemia imposes substantial economic impact even without the direct and indirect cost incurred by patients and other cost of complications. Proper diabetic care and health education is needed in diabetic management to reduce episodes of hypoglycaemia.