SETTING THE ICD-10-AM CODING ENVIRONMENT

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PREPARED BY: ANNA COOTE & HEATHER GRAIN

SETTING THE

ICD-

10 -AM

CODING ENVIRONMENT

‹#›

ARE YOU READY FOR THIS?

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28/09/2014

Today’s Objectives

• Recognise the appropriate tools for clinical coders • Set up physical environments and systems to support quality consistent coding • Assess Clinical Coder levels and skill development required in their environment • Assess the skills required of others, such as IT and clinical staff to support quality coding and data availability • Review the information sources used for clinical coding to improve the utility of the coded data © 2014 ‹#›

Objectives

(continued) • identify uses of ICD‐10‐AM and DRG (casemix) data suited to your environment • Assess the time it would take to develop the clinical coder skills needed to meet identified needs • Identify the quality processes required to support data governance and data collection and use activities. © 2014 ‹#›

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•You are starting down the ICD‐10‐AM Coding route • What are the implications?

Introduction

•Change

•New ways of billing

•Trust

•Implement coding

•New structures

•New jobs

Implications

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Objectives

• Recognise the appropriate tools

for clinical coders

Tools to support coding

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•Coding books •Coding support software • Smart Coder • 3M CodeFinder •eBooks – Turbocoder, CodeXpert •Grouping Software (to produce DRGs and identify outliers) •Drop‐down lists for data capture •Cheat sheets

Coding Tools

CODING BOOKS

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• Coding Support

• Code lookup • Code pathways • Coding automation

• ANDRG Groupers

• Functionality (what they do) • When you use them (at coding, at reporting)

Computer Coding Tools

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Tools and functionality

Tool Coding support ANDRG Grouper Other

3M CodeFinder Automated index Includes coding standards and other references Yes Health eWords SmartCoder Automation of ICD‐10‐ AM production from text ICD‐10‐AM lookup Reference to coding standards, and help Interface – Yes Algorithm – No Advanced disease index facilities Health eWords Smart Termer ICD (as for SmartCoder) and SNOMED CT without additional input Interface – Yes Algorithm – No © 2014 13

SmartCoder ™

SmartTermer ™

SMART CODER & SMART TERMER

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28/09/2014

Eurofield Information Solutions

Alfred Papallo – CEO

Rod Bernard – TurboCoder Sales Manager

The Feel of a Book - The Speed of Technology

For more information visit our website

www.TurboCoder.com.au

Eurofield Information Solutions

Phone: +61 2 9411 3711 Fax: +61 2 9411 3777 E-mail: [email protected]

Code with the ease of the books, but much faster and more accurately!

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• WHAT IS IT?

• WHEN IS IT USED?

• WHAT DOES IT PRODUCE?

• WHERE DOES THE INFORMATION

GO?

• WHAT IS THE INFORMATION USED

FOR?

AN‐DRG GROUPER Software

• Australian government owned algorithm

and data (rules)

• Software licensed by the Aust. Govt uses

an algorithm to convert ICD‐10‐AM codes

into AN‐DRGs

• Multiplies the DRG NWAU by the NEP to

determine the NEP for the AN‐DRG

• NWAU – National weighted activity unit • NEP – National Efficient Price

GROUPER Software

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28/09/2014 Laeta Grouper 3M Grouper Australian Refined Diagnosis Related Groups (AR DRG) •Categorises episodes of care into groups with similar conditions and similar usage of hospital resources.

GROUPER Software Products include:

GROUPER

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•Anatomy textbook

•Dictionary

•Access to the internet

• Abbreviations website or reference

book

•Coding standards

•Copy of ongoing coding decisions

EQUIPMENT FOR THE CLINICAL CODER

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MANAGEMENT OF CODING QUERIES

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CODING QUERIES

QUERY: Modified Karydakis for Pilonidal Sinus/Abscess Operation Report: “flap developed and raised on left hand side, on the right skin dissected off at level of dermis with deeper granulation tissue taken pilonidal sinus tissue removed.” Decision: – code both the excision of the pilonidal sinus and flap repair. The type of flap repair code to use would depend on the depth of the skin flap repair (i.e. myocutaneous vs local skin flap) noted on the operation report. © 2014 25

• _PICQ

• _Audit tools

QUALITY AND IMPROVEMENT TOOLS

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28/09/2014

•Sophisticated sampling of coded

episodes of care

•Automatic comparison of the auditor’s

codes with the Clinical Coder’s codes.

•Uses a classification of coding errors

PHPC CODING AUDIT TOOL

PICQ

TM

_Introduction

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PICQ

TM A Coding Quality Tool • PICQ™ stands for Performance Indicators for Coding Quality • PICQ™ is an auditing tool which identifies records in data sets that may be incorrectly coded • PICQ™ measures coding accuracy by using a set of indicators • PICQ™ is used for benchmarking across health services, hospitals and clinical coders • PICQ™ is used for internal performance management to support: • the continuous review of coding quality, and • review of amended coded data quality Slide 4

PICQ

TM

_{Indicator Degree}

• There are four indicator degrees: • F, Fatal Indicator – any record found by such an indicator has been coded incorrectly by definition • W1, Warning Indicator, 1% threshold – records found by a warning indicator indicates that individual codes or combinations of codes or data items are likely to be incorrect • W2, Warning Indicator, other – records found by a warning indicator indicates that individual codes or combinations of codes or data items are likely to be incorrect (although the record is possibly correct) • R, Relative Indicator – records found by such an indicator are counted and expressed as a ratio of a larger (usually) group of episodes. These indicators would generally be used to assess the overall quality of coded data rather than identify individual problem records

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PICQ

TM

_{Indicator Examples}

Ind. Num Indicator Name Indicator Degree Indicator

Type Rationale Denominator

100248 Admit for dialysis as only diagnosis code, without dialysis procedure code Fatal 2 Comp. "This indicator identifies records with 'admission for dialysis' as only diagnosis code but no dialysis procedure code. ACS 1404 'Admission for renal dialysis' states that the principal diagnosis for a patient admitted for a same day or over one night stay for renal dialysis should indicate the admission is for dialysis. If a patient were admitted for renal dialysis but did not undergo the procedure because of contra‐indications, a code for 'procedure not carried out' should be assigned in addition or the episode cancelled, dependent on the admission policy of your State. Also run Indicators 100240 and 100241 to verify this principal diagnosis is correct for the length of stay." Total records with an admit for dialysis code as the only diagnosis code