News: Cardiovascular emergency diagnoses rarely missed on discharge, JAMA study says

Of emergency room visits attributable to ruptured abdominal aortic aneurysm, acute myocardial infarction, stroke, aortic dissection, and subarachnoid hemorrhage, the conditions were inaccurately diagnosed approximately one out of 20 times, according to a study by the Journal of the American Medical Association (JAMA).

According to the study, these missed opportunities ranged from 2.3% (for acute myocardial infarction diagnoses) to 4.5% (aortic dissection diagnoses) of total visits, JustCoding reported. The study numbers were based on a retrospective cohort study of all emergency hospital Medicare claims submitted between 2006 and 2014. Participants included all fee-for-service Medicare patients admitted to the hospital for the conditions of interest, the study says.

The study estimated the opportunities missed by using the difference between observed and expected discharges within 45 days of the index hospital admissions as the numerator (basing expected discharges on emergency room use by the same patients in earlier months).

The denominator was estimated as the number of recognized emergencies (index hospital admissions) plus unrecognized emergencies (excess discharges), JustCoding reported.

According to the study, the percentage of missed diagnoses were as follows:

• 2.3%, acute myocardial infarction
• 3.4%, ruptured abdominal aortic aneurysm
• 3.5%, subarachnoid hemorrhage
• 4.1%, stroke
• 4.5%, aortic dissection

The study found that trends for missed diagnoses were either insignificant (acute myocardial infarction and aortic dissection) or increasing (ruptured abdominal aortic aneurysm, stroke, and subarachnoid hemorrhage), according to JustCoding.

Editor’s note: This article originally appeared in JustCoding. To learn about the 2018 ICD-10-CM codes related to myocardial infarction, click here. To learn about coding hemorrhages, click here.