{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:54:58Z","timestamp":1790733298980,"version":"4.1.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":88,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"DOI":"10.1186\/s12913-026-15020-0","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T10:53:28Z","timestamp":1783162408000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic coding combination patterns, CHS-DRG severity stratification, and hospitalization expenditure in pneumonia with coexisting hypertension or diabetes mellitus: a single-center cautionary case study of definitional circularity"],"prefix":"10.1186","volume":"26","author":[{"given":"Tingting","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyue","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoJie","family":"L\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"15020_CR1","doi-asserted-by":"publisher","unstructured":"Chen YJ, Zhang XY, Yan JQ et al. Impact of diagnosis-related groups on inpatient quality of health care: a systematic review and meta-analysis. Inquiry. 2023;60:469580231167011. https:\/\/doi.org\/10.1177\/00469580231167011. PMID: 37083281.","DOI":"10.1177\/00469580231167011"},{"key":"15020_CR2","doi-asserted-by":"publisher","unstructured":"Li J, Peng M, Deng S, Wu J, Zhou W. The impact of diagnosis-related groups on medical costs, service efficiency, and healthcare quality in Meishan, China: An interrupted time series analysis. PLoS One. 2025;20(5):e0325041.PMID: 40402973. https:\/\/doi.org\/10.1371\/journal.pone.0325041.","DOI":"10.1371\/journal.pone.0325041"},{"key":"15020_CR3","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.2147\/RMHP.S458005","volume":"17","author":"Z Cao","year":"2024","unstructured":"Cao Z, Liu X, Wang X, Guo M, Guan Z. Impacts of DRG-Based Prepayment Reform on the Cost and Quality of Patients with Neurologic Disorders: Evidence from a Quasi-Experimental Analysis in Beijing, China. Risk Manag Healthc Policy. 2024;17:1547\u201360. https:\/\/doi.org\/10.2147\/RMHP.S458005. PMID: 38894816.","journal-title":"Risk Manag Healthc Policy"},{"issue":"1","key":"15020_CR4","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1186\/s12913-025-13625-5","volume":"25","author":"X Dong","year":"2025","unstructured":"Dong X, Wu J. Does DRG-based payment lead to unintended effects on care quality? A case under global budget with price adjustment in China. BMC Health Serv Res. 2025;25(1):1448. PMID: 41194069.","journal-title":"BMC Health Serv Res"},{"key":"15020_CR5","doi-asserted-by":"crossref","unstructured":"Liu Y, Liao Z, Tan J et al. Impact of DRG policy on the performance of tertiary hospital inpatient services in Chongqing, China: an interrupted time series study, 2020\u20132023. Front Public Health. 2025;13:1523067. PMID: 40109424.","DOI":"10.3389\/fpubh.2025.1523067"},{"key":"15020_CR6","unstructured":"National Healthcare Security Administration of the People\u2019s Republic of China. Notice on the issuance of the 2.0 Version Grouping Scheme for Diagnosis-Related Group (DRG) Payment and Further Advancing Relevant Work: Yi Bao Ban Fa [2024] No. 9. Beijing: National Healthcare Security Administration; 2024 Jul 17 [published 2024 Jul 23]. Available from: https:\/\/www.nhsa.gov.cn\/art\/2024\/7\/23\/art_104_13313.html."},{"key":"15020_CR7","doi-asserted-by":"crossref","unstructured":"Mo G, Zhu E, Fang X et al. Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province. Health Res Policy Syst. 2024;22(1):167. PMID: 39695850.","DOI":"10.1186\/s12961-024-01255-y"},{"issue":"8","key":"15020_CR8","first-page":"849","volume":"13","author":"Y Fu","year":"2025","unstructured":"Fu Y, Gao G, Xing H, et al. Research on the Primary Factors Influencing the Quality of Clinical Coding Under DRG Payment Systems: A Survey Research. Healthc (Basel). 2025;13(8):849. PMID: 40281798.","journal-title":"Healthc (Basel)"},{"issue":"2","key":"15020_CR9","first-page":"1b","volume":"21","author":"Y Zhang","year":"2024","unstructured":"Zhang Y, Dong H, Xu SY, Lyu C, Wei LY. Assessing ICD Data Quality and Its Impact on DRG Payments: Evidence from a Women and Children Special Hospital in China. Perspect Health Inf Manag. 2024;21(2):1b. PMID: 40134895.","journal-title":"Perspect Health Inf Manag"},{"key":"15020_CR10","doi-asserted-by":"crossref","unstructured":"Gabel E, Gal J, Grogan T et al. A retrospective analysis using comorbidity detecting algorithmic software to determine the incidence of International Classification of Diseases (ICD) code omissions and appropriateness of Diagnosis-Related Group (DRG) code modifiers. BMC Med Inform Decis Mak. 2024;24(1):309. PMID: 39443922.","DOI":"10.1186\/s12911-024-02724-8"},{"key":"15020_CR11","doi-asserted-by":"crossref","unstructured":"Albagmi S, Shawaheen M, Asiri EM et al. Assessment of clinical miscoding errors and their potential financial implications on healthcare management: a case of local hospital in Najran, Saudi Arabia. Saudi Pharm J. 2024;32(1):101894. PMID: 38111668.","DOI":"10.1016\/j.jsps.2023.101894"},{"issue":"12","key":"15020_CR12","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1377\/hlthaff.2024.00596","volume":"43","author":"D Crespin","year":"2024","unstructured":"Crespin D, Dworsky M, Levin J, et al. Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011-19. Health Aff (Millwood). 2024;43(12):1619\u201327. PMID: 39626153.","journal-title":"Health Aff (Millwood)"},{"key":"15020_CR13","doi-asserted-by":"crossref","unstructured":"Williams DV, Keller S, McEntee J et al. Enhancing resident note documentation: A quality improvement initiative to accurately capture patient complexity. Am J Med Open. 2025;14:100104. PMID: 40574737.","DOI":"10.1016\/j.ajmo.2025.100104"},{"issue":"7","key":"15020_CR14","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","volume":"200","author":"JP Metlay","year":"2019","unstructured":"Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45\u201367. https:\/\/doi.org\/10.1164\/rccm.201908-1581ST. PMID: 31573350.","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"15020_CR15","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1001\/jama.2014.18229","volume":"313","author":"VF Corrales-Medina","year":"2015","unstructured":"Corrales-Medina VF, Alvarez KN, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313(3):264\u201374. https:\/\/doi.org\/10.1001\/jama.2014.18229. PMID: 25602997.","journal-title":"JAMA"},{"issue":"9596","key":"15020_CR16","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20137. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X. PMID: 18064739.","journal-title":"Lancet"},{"key":"15020_CR17","doi-asserted-by":"publisher","unstructured":"Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, RECORD Working Committee. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015;12(10):e1001885. PMID: 26440803. https:\/\/doi.org\/10.1371\/journal.pmed.1001885.","DOI":"10.1371\/journal.pmed.1001885"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-026-15020-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-15020-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-026-15020-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:30Z","timestamp":1790729730000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12913-026-15020-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["15020"],"URL":"https:\/\/doi.org\/10.1186\/s12913-026-15020-0","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]},"assertion":[{"value":"29 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was reviewed and approved by the Ethics Committee of Anhui Chest Hospital prior to data extraction. Owing to the retrospective study design and the exclusive use of de-identified administrative data, the same Ethics Committee of Anhui Chest Hospital that approved the study also formally waived the requirement for individual informed consent to participate. The study was conducted in accordance with the principles of the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript does not contain any individual person\u2019s identifying images or any other personal or clinical details that could compromise anonymity; all data were analyzed and are reported in de-identified, aggregate form.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable.","order":4,"name":"Ethics","label":"Use of generative artificial intelligence","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1331"}}