Diagnosis-related group front-page management, coding patterns and cost structure in diabetic nephropathy

Abstract

Background: Accurate medical record front-page (discharge summary face sheet) documentation supports diagnosis-related group (DRG) classification and payment review. Evidence on disease-specific management for diabetic nephropathy (DN) remains limited. Objective: To evaluate associations of refined front-page management with complication coding patterns, length of stay, total hospitalisation cost and cost structure in adults admitted principally for DN. Method: We retrospectively compared 48 index hospitalisation episodes in 2023 with 85 episodes from January 2025 to February 2026 at Peking University First Hospital Linquan Hospital. Both periods used the International Classification of Diseases, Tenth Revision, National Clinical Edition 2.0 diagnosis dictionary and China Healthcare Security Diagnosis Related Groups 1.1 framework. Results: Drug cost proportion decreased from 26.7% to 16.1% (difference, −10.6 percentage points; 95% confidence interval (CI), −15.0 to −6.2; standardised mean difference (SMD), −0.97; p < 0.001), while medical service fee proportion increased from 17.9% to 21.3% (difference, 3.4 percentage points; 95% CI, 1.5–5.3; SMD, 0.60; p = 0.001). Total costs were unchanged (median (interquartile range), 3508.56 (2940.07–4186.97) vs. 3475.42 (2902.41–4161.56) RMB; p = 0.850). Coding with E11.700 (Type 2 diabetes mellitus with multiple complications) or E11.700x033 (Type 2 diabetes mellitus with multiple complications, diabetic nephropathy) increased from 0.0% to 52.9% (risk difference, 52.9 percentage points; 95% CI, 40.1–63.2; Cramer’s V = 0.54; p < 0.001), compared with E11.201 + N08.3* (Type 2 diabetes mellitus with diabetic nephropathy; N08.3*, glomerular disorders in diabetes mellitus). Conclusion: Refined front-page management was associated with more service-oriented costs and more complete capture of documented complications, without higher total costs. Implications for health information management practice: Disease-specific checklists and coder-physician review may strengthen payment-related data quality under DRG reimbursement.