National Clinical Coding Qualification (UK) March 2015 Examination Feedback

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National Clinical Coding Qualification (UK)

March 2015 Examination Feedback

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National Clinical Coding Qualification (UK) March 2015

Examination Feedback

The purpose of the feedback is to highlight the most common mistakes made by candidates in the Examination and to provide pointers to help candidates prepare for forthcoming examinations. Generally many candidates were under-prepared across all sections of the March 2015

Examination. Candidates are strongly advised to review the syllabus and bibliography to identify any gaps in knowledge and where necessary agree a development plan with the line manager.

Preparing for the Examination:

Candidates preparing for an examination need to have completed core training and need to be up to date with current coding standards. The following courses are recommended as a minimum before sitting the Examination:

o Clinical Coding Standards Course

o Clinical Coding Standards Refresher Course

o National Clinical Coding Qualification Revision Workshop

Candidates need to plan their study in plenty of time before the Examination.

The Health and Social Care Information Centre – Classifications Service - provides information about the National Clinical Coding Qualification (UK) Syllabus, Bibliography and Study Guidelines. In addition elearning modules: ICD-10 Four Step Coding Process; Basic Anatomy and Physiology and Introduction to Clinical Coding - are useful revision aids when preparing for the examination. Further information can be found at:

http://systems.hscic.gov.uk/data/clinicalcoding/trainingaccred/accreditation/index_html

Sitting the Examination:

You should thoroughly read all instructions provided on the examination paper. Failure to follow specific instructions such as writing a candidate number on every page of the examination paper will result in an unnecessary loss of marks as any unlabelled answers cannot be marked.

Provide all the necessary codes for each question.

Common mistakes:

The following highlights the common mistakes made by candidates sitting the March 2015 Examination:

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Paper 1 – Practical Coding

Section A1

On the whole section A1 was well answered with few mistakes.

Question: Cystic fibrosis with invasive aspergillosis of the lungs

Answer: E84.0 Cystic fibrosis with pulmonary manifestations

B44.0D Invasive pulmonary aspergillosis

J99.8A Respiratory disorders in other diseases classified elsewhere

Most candidates selected the correct primary diagnosis however some candidates lost marks due to failure to notate the J99.8 code with an asterisk.

Question: Apocrine metaplasia

Answer: N60.8 Other benign mammary dysplasias

It was apparent that some candidates had failed to update their ICD10 Volume 3 with the details published in the 03/2014 ICD-10 4th edition (Ref 91 Coding Clinic) errata. The code for apocrine metaplasia was originally R87.7 Abnormal findings in specimens from female genital organs unspecified abnormal findings but this was corrected in the errata to N60.8 other benign mammary dysplasia.

Section A2

Question: On bypass heart transplant from a cadaveric human donor

Answer: K02.1 Allotransplantation of heart NEC

Y73.1 Cardiopulmonary bypass Y99.1 Cadaveric donor

Most errors consisted of candidates selecting a code from category Y01 Replacement of organ NOC.

Question: Mediastinal lymph node biopsy.

Answer: T87.4 Excision or biopsy of mediastinal lymph node

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Marks were lost due to the omission of code O14.2 Sentinel lymph node NEC. Whilst other candidates attempted to code the biopsy of a sentinel lymph node at code T91.1Biopsy of sentinel lymph node NEC and then use the site code Z61.4 Mediastinal lymph node.

Case Studies

Case Study number 1

Candidates lost marks due to the index trails differing from those in the Alphabetical Index: the wording should mirror that of the Alphabetical Index. Candidates also included Tabular List details which are unnecessary and warrants no marks. The question specifically asks for ICD-10 and OPCS-4.7 Alphabetical Index trails only.

Candidates failed to code the primary procedure as a pharyngoscopy as per the general coding standards and guidance PGCS3: Incomplete, unfinished, abandoned and failed procedures. A variety of procedures were coded including gastroscopy and rigid

oesophagoscopy.

Case study number 2

The correct primary diagnosis code was C50.8 Overlapping lesion of breast, as the sites are contiguous and it was not clear which of the two upper quadrants was the point of origin of the carcinoma. Candidates assigned a variety of codes such as C97.X malignant neoplasms of independent (primary) multiple sites, C50.2 Upper-inner quadrant of breast and C50.4 Upper-outer quadrant of breast. Marks were also lost due to the incorrect assignment of morphology codes in particular the assignment of the activity code which should have been /3 indicating primary neoplasm. Answers given included /1 Uncertain whether benign or malignant and /9 Malignant, uncertain whether primary or metastatic site.

Case study number 3

The main error was the assignment of the external cause code. Candidates assigned various codes from various categories including X79 Intentional self-harm by blunt object, Y34

Unspecified event, undetermined intent X83 Intentional self-harm by unspecified means, Y28 Contact with sharp object, undetermined intent and Y29 Contact with blunt object, undetermined intent. The patient punched a wall so the correct external cause code is a code from category W22 Striking against or struck by other objects. It was recorded in the history section of the medical record that the ‘patient abuses alcohol’. Candidates lost marks as they mistakenly used the code Z72.1 Alcohol use.

Case study number 4

Several candidates lost marks due to the incorrect primary diagnosis with answers such as O16.X Unspecified maternal hypertension, O70.9 perineal laceration during delivery,

unspecified and O80.0 Single spontaneous delivery. The code O80.0 Single spontaneous delivery is of particular concern as this code can only be used in a primary position for a delivery if there is no other code from chapter XV Pregnancy, childbirth and the puerperium to be coded. The mother was known to have gestational hypertension. Several candidates included a code from category R32 repair of obstetric laceration which was unnecessary as

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only necessary to code the repair of the episiotomy if it extends to a perineal tear and this is sutured.

Case study number 5

Candidates lost marks due to the omission of laterality codes; the FESS with polypectomy was performed on the right maxillary antrum, and the antral washout was described as a bilateral procedure.

Case study number 6

This was well answered with very few mistakes.

Case study number 7

Several candidates lost marks due to the reversal of assigning a † symbol to code N08.3 Glomerular disorders in diabetes mellitus (E10-E14 with common fourth character .2† and assigning an * symbol to code E11.2 Non-insulin-dependent diabetes mellitus with renal complications Diabetic nephropathy (N08.2*). While it is noted that dagger and asterisk codes can be reversed the symbols indicating the dagger and asterisk should be assigned to the original codes. It is possible to create dagger codes but asterisk codes are

predetermined and cannot be created. The patient had diabetic nephropathy. Marks were also lost due to a variety of incorrect codes including E11.6† M14.2* for diabetic arthropathy and E11.4† G63.2* for diabetic neuropathy.

Many candidates lost marks as they only included one dialysis session, the patient underwent a total of four sessions and each should have been coded using X40.3 Haemodialyis NEC.

Paper 2 – Theory

Section C

General Theory Short Questions

Question: In hybrid knee joint replacement how is the cemented component indicated in

OCPS-4 coding?

Answer: By site coding the cemented component only.

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Question: Describe two exceptions to the general coding rule for coding diagnostic versus therapeutic procedures. (No actual codes are required.)

Answer: ERCP together with sphincterotomy of sphincter of Oddi.

ERCP with therapeutic procedure

Therapeutic D&C with diagnostic hysteroscopy

Therapeutic endoscopic procedure (excluding excisions) with biopsy This list was not considered exhaustive.

Many candidates simply stated ERCP without adding an additional procedure.

Question: What is the key task for the clinical coder in relation to the medical terminology found

in the patient’s medical record?

Answer: Translation of the medical terminology into classification codes.

Candidates failed to include the word translation in their answers which is fundamental to the role of clinical coders.

Question: Why is the use of the filler ‘X’ character mandatory when assigning codes in the

Patient Administration System?

Answer: So codes are of a standard length for data processing (and validation).

Some candidates answered that this was to allow the assignment of 5th characters and others answered that it was to maintain the structure of the classification.

Paper 2 – Section D1

General Theory ICD-10 questions

Question: List the sequencing for how a syndrome should be coded when manifestations are

known and one of these manifestations is the main condition treated.

Answer: The manifestation being treated must be the primary diagnosis

Any other known manifestations should then be recorded The appropriate code for the syndrome itself is entered last

Candidates lost marks as they failed to identify the correct sequencing.

Paper 2 – Section D2

General Theory OPCS-4 questions

Question: What constitutes a multidisciplinary non-specialised team for a Rehabilitation

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Answer: A team of two or more clinical professions within local therapy/support services.

Question: What constitutes a unidisciplinary specialised team?

Answer: A team (or individual) from a single clinical profession within district specialist

services(s).

Very few candidates gave the full definitions for these two questions or gave examples which directly contradicted the definition they had provided.

Question: What are the four levels of complexity that occur within a body system chapter of

OPCS4.7, Tabular List Volume 1? Provide an example of a type of

procedure/intervention that falls into each level (no actual codes are required).

Answer: Major Total removal or functional replacement or transplant

Intermediate Partial removal or partial deconstruction or reconstruction or repair

Minor Biopsy or incision or aspiration

Non-operative

procedures Injection or Examination or Scan/Imaging or Screening

Most candidates provided four levels of complexity but did not always provide the correct four – the most frequent omission was Non-operative procedures. The examples provided didn’t always match the complexity levels e.g. major – partial excision of stomach which is an example of an intermediate procedure.

Paper 2 – Section D3

Clinical Terms

Questions within this section continue to be badly answered. In Part A Candidates gave specific standards in ICD-10 or OPCS-4 rather than sources of standards and listed benefits of an EPR rather than SNOMED CT itself. In Part B there was a lot of duplication and

repetition with the same answers being provided in several different ways.

Paper 2 – Section D4

Miscellaneous Questions

Only a quarter of candidates opted for part A, and this question was not answered as well as part B.

Question: Briefly describe the clinical statement you would expect to find in a patients care

record that would lead to the assignment of a code from category Y78 Arteriotomy approach to organ under image control.

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Answer: There must be evidence in the source document to indicate an arteriotomy has been performed with the use of the certain medical terminology present in the clinical statement including e.g. incision into artery, a surgical cut-down, or cutting of an artery.

Either sutures or clips must be used to close the arteriotomy. Image control must be mentioned.

Some candidates failed to state that sutures or clips must be used to close the incision and that image control must be mentioned.

Question: List four of the different types of ICD-10 codes that cannot be used is a primary

diagnostic position. (No actual codes required).

Answer: Morphology codes, Sequelae codes, External cause codes, Certain codes from

Chapter XXI (Z codes), Adverse effect codes, Certain codes designated as subsidiary by classification rules e.g. B95-B98, U80-U89 Bacterial agents resistant to antibiotics In section B several candidates listed specific codes rather than types of codes. Some examples given were too vague e.g. all codes in Chapter XXI- this is not correct as some of these codes can be used in a primary position. Some candidates failed to read the question and included examples of OPCS4.7 codes that could not be used in a primary position.

Paper 2 – Section E1

Anatomy & Physiology

Question: What is our true organ of hearing?

Answer: The organ of Corti.

Many candidates left this blank; some gave the answer ‘the ear’.

Question: What is the name of the space between the vagina and the rectum or the scrotum

and the rectum?

Answer: Perineum

The most common incorrect answer to this question was peritoneum.

Paper 2 – Section E2

Medical Terminology

Question: When is a combining vowel used in the construction of a medical word?

Answer: When two consonants fall together where prefix, root or suffix meet each other.

Answers included to link a prefix to a suffix and ‘to link words’- this did not provide enough detail to warrant the mark.

Paper 2 – Section E3

Diagrams

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On the whole this section was well-answered. Candidates lost marks due to only giving part answers to the diagrams. It was clear that some people did not know the diagrams at all and gave the same anatomical description for multiple answers.

Spelling is taken into account during the marking of the anatomy and physiology section and this is important as incorrect spelling may indicate a completely different body part e.g. ilium, ileum.

Further information:

The Institute of Health Records and Information Management (IHRIM) is primarily an educational body and provides qualifications at different levels as well as career and professional assistance for members.

The Institute encourages professionalism and a structured examination system exists for those who wish to obtain a professional qualification.

IHRIM is the awarding organisation for the National Clinical Coding Qualification.

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