The Casemix Team’s Role in Addressing the Indonesian Coding Standard in the Implementation of INA-CBGs at Toto Kabila Bone Bolango Ragional Hospital

Abstract

Background: The implementation of INA-CBGs requires accurate clinical coding and complete medical documentation because diagnosis and procedure codes are used in the case grouping and claim process. The case-mix team therefore has an important role in ensuring the completeness, accuracy, verification, and coordination required for claims. This study aimed to analyze the role of the case-mix team in implementing the Indonesian Coding Standard (ICS) within INA-CBGs at Toto Kabila Bone Bolango Regional Hospital.

Methods: This study used a descriptive qualitative design. The research was conducted at Toto Kabila Bone Bolango Regional Hospital in May–June 2026. Five informants were selected purposively: the Head of the Medical Records Installation, a case-mix officer, a coder, a medical-record staff member, and a physician. Data were obtained through interviews, direct observation, and documentation. Data analysis involved data reduction, data display, and conclusion drawing with verification through triangulation.

Results: The case-mix team performed medical-record completeness checks, diagnosis and procedure coding, internal verification and validation, and coordination with physicians and medical-record personnel. Coding was guided by ICD-10, ICD-9-CM, the Indonesian Coding Standard, and hospital procedures. However, implementation was constrained by incomplete electronic medical-record data, diagnoses that were not sufficiently specific, the need for clarification with the attending physician, coder workload, limited updating/training, and coordination that was not always optimal. The team responded through repeated verification, clarification with physicians, application of coding SOPs, use of coding guidelines, and strengthening interprofessional communication.

Conclusion: The case-mix team has an important operational and quality-control role in supporting ICS implementation and INA-CBGs claims at Toto Kabila Hospital. Continued improvement in documentation quality, coder competency, periodic coding training and updating, routine audit, and interprofessional coordination is needed to support more consistent coding and smoother claim processing.