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The International Classification of Diseases (ICD-10) was introduced in a pilot phase for coding of diagnoses in a sample of cases encountered in the Swiss Disability Insurance (SDI), as a substitute for the SDI codes, judged unsuitable for the description of disability. The goal of this study is to evaluate the reliability of use of these codes, by studying the coding reproductibility between the Medical Observation Centers (MOC) and the Evaluation and Coordination Center. A second goal was to evaluate the feasibility of coding by non-physicians. Reliability of diagnoses was examined by level of precision: chapters, groups, categories and subcategories. The agreement between the two coding Centers varies from 78%, at the chapter level, to 29% at the most detailed level. This agreement is improved if taking into account the three main diagnoses for the comparison, reaching 91%. The results of the physician coder, concerning the precision and reliability of coding, are significantly superior to those of an economist coder and a medical secretary coder. To improve coding agreement, it is proposed to train coding professionals, provide coding tools, clarify which diagnosis is the main one, and seek a consensus for cases of systematic disagreement. The ideal level of precision should not be so high as to produce diagnostic codes with low reliability. It should, however, be precise enough to give a satisfactory description of the problems encountered. |
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