Development and Content Validation of a Clinical Coding Quality Audit Instrument: A Modified Delphi Study

Abstract

Reliable clinical coding is fundamental to high-quality health information. However, existing clinical coding audit approaches remain heterogeneous, frequently focusing on isolated quality indicators and lacking comprehensive, content-validated instruments for systematically evaluating clinical coding quality. This study aimed to develop and establish the content validity of the Indonesian Clinical Coding Quality Audit Instrument (IAMPK). A methodological instrument development study was conducted using a two-round modified Delphi technique involving seven experts in clinical coding, health information management, and health informatics. Candidate indicators identified through a comprehensive literature review were refined through expert consensus, and content validity was evaluated using the Item Content Validity Index (I-CVI), Scale Content Validity Index (S-CVI/Ave and S-CVI/UA), and Aiken's V. The final IAMPK comprised six domains and 32 indicators encompassing coding accuracy, coding completeness, sequencing accuracy, compliance with coding standards, documentation quality, and claim impact. Consensus was achieved for all indicators after two Delphi rounds. The instrument demonstrated excellent content validity, with all content validity indices meeting or exceeding recommended thresholds, supporting its suitability as a multidimensional framework for clinical coding quality audit. The IAMPK provides a standardised, multidimensional, and content-validated framework for evaluating clinical coding quality. This instrument offers a strong foundation for future psychometric evaluation and implementation to support consistent clinical coding quality assessment and continuous quality improvement in health information management.