La actualización de la Codificación Clínica en Irlanda Updating Clinical Coding in Ireland

La actualización de la Codificación

Clínica en Irlanda

Updating Clinical Coding in Ireland

El Camino hacia IDC-10

The Journey to ICD-10

Updating Clinical Coding in Ireland

The Journey to ICD-10

Deirdre Murphy

Health Research and Information Division Economic and Social Research Institute (ESRI)

Dublin, Ireland.

Hospital InPatient Enquiry

(HIPE)

ƒActivity data on Inpatient and Day cases in

all HIPE Public hospitals in Ireland.

ƒ Each time a patient is discharged (or dies)

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Clinical Research

Service Planning

Health Policy

Epidemiology

Casemix

Consultant workload

ƒ

ƒ ƒ ƒ ƒ

Contracted by Health Service Executive (HSE) to manage, collect and compile HIPE National Files Supports and trains all clinical coders

Responsible for timely and accurate national files HIPE software

Provides national HIPE statistics

AUDIT HIPE National Database ESRI Reporting Training

Data onto HIPE system Monthly export to ESRI Discharge summary Validation Patient discharged

Classifications used in Ireland to date:

1969 - 1980 ICD-8 1981 - 1989 ICD-9 1990 - 1994 ICD-9-CM (Oct 88) 1995 - 1998 ICD-9-CM (Oct 94) 1999 - 2004 ICD-9-CM (Oct 98) 2005 – 2008 ICD-10-AM (4th _Edition) OPCS Procedure classification

Coding in Ireland

ƒ ƒ st ƒ ƒ

250 coders including part-time and full time Nominated by hospitals from administration aff

Approx 1.3m records from 60 hospitals

A full time coder may code between 7000-8000 records per year depending on experience & specialties.

Coding in Ireland

ƒ Coders are supported at hospital level by

the HIPE/Casemix coordinator (HCC).

ƒ The ESRI provides training and support to

all coders, HCCs and other personnel involved in coding in Ireland.

ƒ

Over 96% coverage

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Data complete by 6 weeks of

discharge

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Casualty and Outpatient data

NOT collected

ƒ Basic Coding Course

Module 1 - 2 days,

Module 2 - 3 days (6 weeks later)

ƒ Intermediate Coding Course – 3 Days ƒ Specialty Workshops – 1 Day

ƒ Coding Refresher Course – 3 Days ƒ Update courses

Specialty Workshops

ƒClinical and coding information on specialty areas e.g.

ƒ Neoplasms,

ƒ Obstetrics and Gynaecology, ƒ Cardiology,

ƒ Diabetes.

ƒExpert speaker to address the clinical aspects of the topic.

Continuing Education

ƒ

ƒ

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Hospital based training

Regional workshops

Query Process

Coding Queries

ƒ

Database of coding queries maintained

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Clinical advice available

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Up-to-date reference material maintained

Data Quality

ƒ Education on data quality initiatives for key

personnel

ƒ Coding Audit Toolkit

ƒ Information on conducting data reviews ƒ Monitoring of queries issued

ƒ Communication with hospitals ƒ Coding Standards

ƒ Chart based Coding audits ƒ Scrutinising national data

ƒ Training developments based on audit findings ƒ Local involvement in audit process

ƒ Track & record all audit activity ƒ Training for audit role

Coding Notes

ƒ New or amended guidelines

ƒ New Codes

ƒ I.T. Information ƒ Help and guidance

ƒ Developments in HIPE

ƒ Upcoming Courses

ƒ Coding Queries ƒ Coding Features.

Coding Notes

• Issued to all involved in HIPE

• Available by e-mail • All issues available on

Windows HIPE

Data Entry System Windows HIPE Reporter

ICD-10-AM

eBook Windows HIPE Batch Coder

HIPE Audit

ƒ All HIPE records are keyed using the HIPE

PC data entry system

ƒ Validation checks

ƒ Standard format

ƒ Hospitals with PAS/HIS systems can

ƒ W-HIPE data entry system

ƒ W-HIPE Reporter

ƒ Audit – Local & National ƒ Training Courses

ƒ Training Materials ƒ Selector Checks

ƒ Roundtable meetings ƒ Coding Notes

ESRI Supports:

ƒ Training

ƒ Classification - Books

ƒ W-HIPE - Data entry & Reporting software ƒ Audit Function

ƒ Coding Notes

ƒ & all support to help hospitals to provide data to the HIPE National DataBase

Coders’ Roles

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Data Management

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Communication

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Quality

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Training

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Liaison

Data Quality-National Level

Data quality framework

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Edits

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Training of coders

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Clinical Classification & Coding Standards

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Coding query clearing house available to coders

Data Quality-National Level

Data quality framework

ƒ

Edits

ƒ

Training of coders

ƒ

Clinical Classification & Coding Standards

ƒ

Coding query clearing house available to coders

ƒ W-HIPE data entry system

ƒ W-HIPE Reporter

ƒ Audit – Local & National ƒ Training Courses

ƒ Training Materials ƒ Selector Checks

ƒ Roundtable meetings ƒ Coding Notes

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Produce reports on hospital activity

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Routine quality control

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Used also at national level

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All hospitals receive queries and most are

Common Findings

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Quality of documentation

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Levels of clinician involvement

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Coder training

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Coding Issues

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Communication

Classifications used in Ireland to date:

1969 - 1980 ICD-8 OPCS Procedure 1981 - 1989 ICD-9 classification 1990 - 1994 ICD-9-CM (Oct 88) 1995 - 1998 ICD-9-CM (Oct 94) 1999 - 2004 ICD-9-CM (Oct 98) 2005 – 2008 ICD-10-AM (4th _Edition)

1. A review of countries who actively develop

ICD-10 and procedure classifications

U.S.A.

Nordic Block Australia Canada

2. Pilot of ICD-10-AM (3rd _Edition)

Updating Clinical Coding in Ireland:

Options and Opportunities

What is needed from a Classification?

9

Composite Coding Scheme

9

Regular Updates

9

Training and Support

ICD-10-AM

9

Composite Coding Scheme 9 ICD-10-AM & ACHI

9

Regular Updates _{9 Biennial}

9

Training and Support _{9 NCCH}

9

International Comparability ₉

Also

The Minister for Health and Children, formally announced the move at the

Annual National Casemix Conference in April 2004 by stating

“Moving to ICD-10AM will bring us fully up-to-date in clinical coding”

Pilot of ICD-10-AM

HIPE Unit, ESRI

& 6 HIPE Hospitals

The Pilot had two major strands:

1. The appropriateness of the

classification to the Irish hospital setting

2. The readiness of the Irish Hospital Clinical Coder to adopt this coding scheme, which demands even more self-education and regulation of

The Pilot

ƒ 474 charts coded

ƒ 11 coders

HIPE Unit, ESRI

December 2002 – February 2003

3 PHASES IN THE PILOT

Phase 1. HIPE Pilot Project team preparation Phase 2. Hospital and coders

Data collection

HIPE Unit, ESRI

December 2002 – February 2003

Phase 1

September – November 2002

ƒ Interest volunteered by Irish hospitals ƒ Pilot site selection

ƒ Resource acquirement

HIPE Unit, ESRI

December 2002 – February 2003

Phase 2

November 2002 – January 2003

ƒ Training and Education - Pilot Hospital coders ƒ Hospital based exercise - Dual Coding study ƒ Data and feedback collection

HIPE Unit, ESRI

December 2002 – February 2003

Phase 3

February – April 2003

ƒ Compilation of pilot study sample data ƒ Data entry of coded cases

ƒ Analysis & evaluation of pilot study ƒ Final report

1 Extensive excision of

skin and subcutaneous tissue for sycosis, 31245-03

1 Excision of sinus of

skin and subcutaneous tissue

30099-00

3 Excision of lesion of

skin and subcutaneous tissue of leg

31235-03

1 Radical excision skin lesion

86.4 5

Excision of lesion of skin and subcutaneous tissue of other site 31205-00

14 Other local excision or

destruction of skin 86.3

5 Excision of lesion of

skin and subcutaneous tissue of other site of head 31235-00 No Procedure ICD-9-CM CODE No Procedure ICD-10-AM CODE

Table 23 - Procedure codes recorded in ICD-9-CM in Pilot Study that would not normally be collected in ICD-10-AM according to ACS 0042

…

..

etc

4 ECG monitoring 89.54 5 Electroencephalogram 89.14 6 Diagnostic ultrasound-urinary 88.75 6 Inject/infuse NEC 99.29 7 Electrocardiogram 89.52 7 Diagnostic ultrasound-heart 88.72 9 Diagnostic ultrasound -head/neck

88.71

26 Routine chest X-ray

87.44 38 Injection antibiotic 99.21 Code Count Procedure ICD-9-CM Code

Summary Results of Pilot

ƒ Chart documentation to improve.

ƒ Adherence to coding guidelines mandatory. ƒ Medical terminology to be improved.

ƒ Self education and responsibility for

Summary Results of Pilot

ƒ The commitment of coders and HCCs to support

data quality initiatives is vital to HIPE.

ƒ There is a need for renewed efforts to ensure

compliance with national coding guidelines by all clinical coders.

Summary Results of Pilot

ICD-10-AM could be:

• Used successfully by coders in Irish

hospitals and was

ICD-10 ICD-10-AM

ƒ There is no change in the structure of ICD-10 ƒ The meaning of the three character and four

character codes in ICD-10 are not changed

ƒ Any modifications are consistent with existing ICD-10

codes and conventions

ƒ The ability to compare ICD-10-AM data with ƒ ICD-10 data over time is not compromised.

Features of ICD-10 maintained in ICD-10-AM include:

ƒ Alphanumeric codes

ƒ Inclusion of codes for post-procedural disorders at

the end of each appropriate chapter

ƒ A change of the axis for classifying injuries from type

of injury in ICD-9-CM to body site in ICD-10

Australian Coding Standards – Volume 5

ƒ

Coding conventions/definitions

ƒ Clinical and coding information

Indexed in Volume 1 and Volume 3 as appropriate.

ƒ

Coding Matters

between editions

E-Book for ICD-10-AM

In addition to the books, an e-book, a searchable CD-ROM version of all the volumes of

ICD-10-AM accompanies the

5-volume sets.

Coding Matters

ƒ Coding Matters is the

quarterly newsletter of NCCH (Sydney).

ƒ Any changes in practice are

expected to be implemented by coders once they have been published in Coding

. Matters

What’s the same?

ƒ Extraction of information from charts ƒ Selection of main term, ICD code and

verification in tabular

ƒ Definition of the Principal Diagnosis ƒ Guidelines e.g.

What’s different?

ƒ 5 books /E-Book

ƒ Australian Coding Standards

ƒ 7-digit codes for Procedures presented

What’s different?

Secondary/additional diagnoses

ƒ NCCH has tightened the definition of additional

diagnoses to limit coding of conditions to only those that affect patient management in a

significant way.

ƒ An additional diagnosis should not be routinely

coded just because a patient is on ongoing medication for treatment of this condition.

Anaesthetics

Anaesthetic codes are collected in ICD-10-AM when a procedure is performed.

ƒ General Anaesthetic and Sedation are always coded ƒ Anaesthetic codes require a two-character

extension,which represents the patient's ASA American Society of Anaesthesiologists) score.

Australian Coding Standard 0042 Procedures normally not coded lists procedures not coded because they are usually:

ƒ routine in nature

ƒ performed for most patients and/or

ƒ can occur multiple times during an episode

ƒ the resources used to perform these procedures

are often reflected in the diagnosis or in an associated procedure.

Examples of procedures listed under

ACS 0042 Procedures normally not coded:

ƒ Application of plaster

ƒ Primary suture of surgical

ƒ Dressings _{and traumatic wounds} ƒ Drug treatment _{ƒ Ultrasound}

ƒ Echocardiogram _{ƒ X-rays without contrast}

(plain)

ƒ Postprocedural urinary

Implementation In Ireland

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2004 – Introduce the Classification

Training – 2004

ƒ

Coding Notes

- March 2004 & following editions.

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A series of One Day workshops and

introductory days held nationally

in 2004

Preparation Advice

ƒ

Communicate with hospital staff

ƒ Improve chart documentation

ƒ Tackle Backlogs to cut down on the Dual Coding

Period

Australia

ƒ 3 members of HIPE Data Quality and

Training group from ESRI travelled to Australia in May 2004

1- Training

2 - Data Quality

ƒ Train the trainer week in NCCH Sydney

Initial stages April – July 2004

W-HIPE data entry and reporting software amended

Edits reviewed

Liaison by phone and email with NCCH Ordering of books/eBooks

Organise Phase 1 training courses

Ireland

Phase 1 – Training given by ESRI Staff

A series of 2-day introductory workshops were held across Ireland from August to December 2004.

Phase 2 - Training given by NCCH

In January 2005 two trainers from NCCH travelled to Ireland and spent 2 weeks conducting 4 workshops.

Phase 3 – Training given by ESRI Staff

Coding Notes

provided

information on

the

Phase 1 - Two-day workshops

ƒ 15 held nationwide – Autumn 2004

ƒ 15 sets of books available & eBooks

ƒ Smaller groups for Introductory

phase

ƒ Evaluation forms for preparing January

Phase 1 Two-day workshops

Agenda

ƒ Introduce the Classification

ƒ Conventions used in ICD-10-AM ƒ Australian Coding Standards

ƒ Principal diagnosis ƒ Additional Diagnoses

Tools available at Phase 1 courses

ƒ Workbooks

ƒ Posters

ƒ Exercises

Other preparations for hospitals

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Tackle Backlogs

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Stabilize coding team

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Appoint Ten Team Leader

Phase 2 – January 2005

ƒ Workshops held in January 2005 - two

NCCH trainers conducted four 2-day workshops.

ƒ Each workshop had about 50 attendees. ƒ Dedicated separate training sessions on

ICD-10-AM Training

Phase 2 – January 2005 – with NCCH

Cork

Dublin

Galway 2 courses

Phase 3 - ESRI

April to June 2005

1-Day workshops (11 nationwide)

Dublin – 3x courses SE x 1 course West – 1 x courses NE – 1 x courses Midlands – 1 x course Cork Dublin Galway Midwest – 1 x courses

Phase 3

Sligo – 1x course

Impact of ICD-10-AM

ƒ Develop and phase in new training ƒ Australian Coding Standards (ACS) ƒ Workshops throughout 2005

ƒ Irish Coding Standards developed to

Impact of ICD-10-AM

ƒ Coverage

ƒ Audit

ƒ Quality Review ƒ Training Review

ƒ WHIPE Data Entry software

Impact of ICD-10-AM

Coverage

By end of April 2005

ƒ

Over 85% of ‘new year’ coded

compared to same time last year

for 2004.

Impact of ICD-10-AM

Data Quality

ƒ

Work on the quality of ICD-10-AM coded

data commenced early in 2005.

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An audit in February 2005 showed good

compliance and understanding of

ICD-10-AM.

Transition

ƒ

Coding Courses now all in ICD-10-AM

ƒ

Work on edits in W-HIPE ongoing

A successful implementation

ƒ A focused 3-phased national training plan

undertaken by the ESRI in collaboration with the NCCH in Sydney.

ƒ Additional information has been provided

regularly to coders through

Coding Notes

.

ƒ The support of the Department of Health and

Children, the hospitals, coders and HCCs is also acknowledged as crucial to the implementation.

Ongoing..

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Ongoing timely and accurate

HIPE data.

ƒ

Update to future editions ICD-10-AM

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Data Quality Framework

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Development of software

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Irish Coding Standards (ICS)

ƒ

Accreditation for coders

ƒIrish Coding Standards have been developed to

be used in conjunction with the Australian Coding Standards.

ƒCoders need to be familiar with ICS

ƒICS are not indexed in the ICD-10-AM

Future Directions

ƒ

ICD-10-AM

Future Directions

ƒ

ICD-10-AM – 7

th

Edition

ƒ

NCCH contract runs to end July

2010 (publication 7

th

_Edition)

ƒ

Future of ICD-10-AM at NCCH

Accreditation for Coders

ƒ Accreditation of clinical coder training provided by

the ESRI.

ƒTechnological advances for training opportunities ƒ Linkage to Grading & Pay to training.

Benefits to workforce

ƒ more stable, ƒ skilled

ƒ qualified,

ƒ appropriately remunerated coders ƒ recognised clinical coding profession

Benefits to system

For any further information

Deirdre Murphy,

Health Research and Information Division, ESRI

¡Gracias por su

atención!