Descriptive Study of Factors Related to The Accuracy of The Diagnosis Code of TB (Case Study in 2 Hospitals and 1 Puskesmas) in Semarang City in 2019

Abstract

The results of the initial survey at 2 hospitals and 1
health center found that the determination of the TB disease
code was still inaccurate because it was not based on
supporting examinations and especially at the Puskesmas
it only coded 3 digits. This study is to describe the factors
associated with the accuracy of the diagnosis code of TB.
This research uses descriptive research with observation
and interview methods and the instruments used in this
study are observation guidelines in the form of checklists
and questionnaires. The subjects of this study were 8
coding officers at the hospital and 3 coding officers at the
Puskesmas. 100% coding officers in hospitals are D3RMIK
graduates and 100% coding officers at Puskesmas are
doctors, coding officers at the hospital who answered did
not fill in the doctor’s diagnosis 1 (12.5%), there was no
socialization of SOP coding 2 (25%) and doctors did not
fill in the complete history 1 (12.5%), the staff’s knowledge
of TB coding at the Puskesmas was insufficient, namely
the procedure for using ICD (100%) and medical terms/
medical terminology (100%), all hospital coding officers
did not comply with 1 part SOP where the coder submits
DRM RI to Filling (100%), the puskesmas coding officer
from the 9 SOP steps in coding found that there were 5
(55.6%) non-compliant steps.