Medical Classification and Coding Systems (in order of development)

Transcription

1 Medical Classificatin and Cding Systems (in rder f develpment) Cding System Descriptin Lndn Bills f Mrtality Develped during the latter part f the 16th century Cnsidered the first classificatin system Bills were cllected and cllated by parish clerks (with n medical training). Nslgia Methdica Medical classificatin system develped in the mid-1700s by Françis Bssier de Lacrix (Sauvages) Bertilln Internatinal Statistical Classificatin f Causes f Death Manual f the Internatinal Statistical Classificatin f Diseases, Injuries, and Causes f Death (ICD-6) Classificatin f diseases by site, adpted in 1893 Subsequent revisins were entitled Internatinal List f Causes f Death (ICD-1, ICD-2, ICD-3, and ICD-4). Classificatins f diseases fr mrbidity reprting purpses were integrated int subsequent revisins. ICD-5 added mental diseases and deficiency (mental deficiency, schizphrenia, manic depressive psychsis, ther mental diseases). In 1946, the Wrld Health Organizatin (WHO) revised ICD-6 and established an Internatinal List f Causes f Mrbidity. Adpted internatinally in 1948 by the First Wrld Health Assembly WHO reviews and revises ICD abut every 10 years: ICD-7 (1955) ICD-8 (1965) ICD-9 (1975) ICD-10 (1989, with WHO member states adpting in 1994) ICD-10 is entitled the Internatinal Statistical Classificatin f Diseases and Related Health Prblems (ICD-10) and differs frm ICD-9, as fllws: Mre detailed (8,000 categries vs. 4,000 in ICD-9) Uses 3-digit alphanumeric categry cdes (vs. 3-digit numeric categry cdes in ICD-9) Cntains three additinal chapters, and ther chapters have been rerganized Cause-f-death titles are mdified and cnditins rerganized Sme cding rules have changed Published in three vlumes (vs. tw vlumes in ICD-10) The United States has nt yet adpted ICD-10, and current implementatin predictins are 2010.

2 Cding System Internatinal Classificatin f Diseases, Adapted fr use in the United States (ICDA) Descriptin The United States adapted ICD-8 in 1966 t include additinal detail fr cding hspital and mrbidity data, abbreviated ICDA-8. In 1968, The Cmmissin n Prfessinal and Hspital Activities (CPHA) f Ann Arbr, Michigan, published a hspital adaptatin f ICDA, entitled H-ICDA, which was revised in 1973 as H-ICDA-2. U.S. hspitals were divided in their use f ICDA-8 and H-ICDA (and later H-ICDA-2). Authr Green recalls cding inpatient cases fr the medical recrd department using ICD-9-CM in 1979, while her utilizatin review crdinatr cded the same cases accrding t H-ICDA as required by the cunty prfessinal standards review rganizatin (PSRO), which mnitred the apprpriateness, quality, and utcme f the services prvided t beneficiaries f the Medicare, Medicaid, and Maternal and Child Health Prgrams. In 1982, PSROs were replaced by statewide peer review rganizatins, r PROs. Effective 2002, they are called quality imprvement rganizatins, r QIOs. In 1979, all hspitals were required t adpt the Internatinal Classificatin f Diseases, Ninth Revisin, Clinical Mdificatin (ICD-9-CM), which classifies diagnses (Vlumes 1 & 2) and prcedures (Vlume 3) all hspitals and ambulatry care settings (including physician ffices) use ICD-9-CM t reprt diagnses; hspitals use ICD-9-CM prcedure cdes t reprt inpatient prcedures and services. The Natinal Center fr Health Statistics (NCHS) is the federal agency respnsible fr develping ICD-10-CM. The ICD-10-PCS (Prcedure Cding System) was develped with supprt f the Health Care Financing Administratin (nw called Centers fr Medicare & Medicaid Services) under cntract t 3M Health Infrmatin Systems. The Natinal Cmmittee n Vital Health and Statistics (NCVHS) serves as a public advisry bdy t the Secretary f DHHS in the develpment f ICD-10-PCS. ICD-10-CM and ICD-10-PCS have nt yet been adpted fr use in the United States. Once the final rule abut adpting ICD-10-CM and ICD-10-PCS is published in the Federal Register, prviders will have tw years t implement the cding systems. The Federal Register is a legal newspaper published every business day by the Natinal Archives and Recrds Administratin (NARA) and is available in paper frm, n micrfiche, and nline. Medical Classificatin and Cding Systems, page 2

3 Cding System Descriptin Diagnstic and Statistical Manual f Mental Disrders (DSM) Published by the American Psychiatric Assciatin as a standard classificatin f mental disrders used by mental health prfessinals in the United States DSM (1952) DSM-II (1968) DSM-III (1980), and a multiaxial classificatin was added: Axis I mental disrders r illnesses (e.g., substance abuse) Axis II persnality disrders r traits (e.g., mental retardatin) Axis III general medical illnesses (e.g., hypertensin) Axis IV life events r prblems (e.g., divrce) Axis V glbal assessment f functining (GAF) (e.g., ccupatinal) DSM-III-R (1987) DSM-IV (1994) DSM-IV-TR (2000) (Text Revisin t crrect DSM-IV errrs, update cdes accrding t ICD-9-CM annual revisins, and s n) DSM-V (expected in 2011) Derived frm ICD-9-CM, designed fr use in a variety f health care settings, and cnsists f three majr cmpnents: Diagnstic classificatin Diagnstic criteria sets Descriptive text Medical Classificatin and Cding Systems, page 3

4 Cding System Descriptin Current Prcedural Terminlgy (CPT) Originally published by the American Medical Assciatin (AMA) in 1966 Subsequent editins were published abut every five years, until the late 1980s when the AMA began publishing annual revisins f CPT-4 (nw abbreviated as CPT). The CPT-5 Prject was initiated by the AMA in 2000 t address challenges presented by emerging user needs, the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA), and needed imprvements in CPT. The primary gal f the CPT-5 Prject was t have CPT chsen by the Secretary f Health and Human Services as the natinal standard prcedure cde set fr physician services under HIPAA. A Final Rule, issued in the August 17, 2000, Federal Register, named CPT as the natinal standard cde set fr physician services. CPT-5 Prject recmmendatins are implemented annually alng with cde additins, deletins, and revisins. CPT classifies prcedures and services. Physicians and ambulatry care settings (e.g., hspital utpatient care) assign CPT cdes t reprt prcedures and services. CPT is level I f the Healthcare Cmmn Prcedure Cding System (HCPCS). Internatinal Classificatin f Diseases fr Onclgy, third editin (ICD-O-3) Internatinal Classificatin f Injuries, Disabilities, and Handicaps (ICIDH) First editin f ICD-O was published in 1976, and a revisin (primarily f tpgraphy cdes) was published in 1990 ICD-O-3 was implemented in digit cde, which describes the tumr s primary site (4- character tpgraphy cde), histlgy (4-digit cell type cde), behavir (1-digit cde fr malignant, benign, and s n), and aggressin (1-digit differentiatin r grade cde) Published in 1980, ICIDH classifies health and healthrelated dmains that describe bdy functins and structures, activities, and participatin. In 2001, with publicatin f its secnd editin, the name changed t Internatinal Classificatin f Functining, Disability and Health (ICF). ICF cmplements ICD-10, lking beynd mrtality and disease. Medical Classificatin and Cding Systems, page 4

5 Cding System Descriptin HCPCS Level II (natinal cdes) Published by a variety f vendrs, the cding system is in the public dmain, which means it is nt cpyrighted. Managed by the Centers fr Medicare & Medicaid Services (CMS) Classifies medical equipment, injectable drugs, transprtatin services, and ther services nt classified in CPT. Physicians in ambulatry care settings use HCPCS Level II t reprt prcedures and services HCPCS Level I lcal cdes were discntinued in They had been managed by Medicare carriers and fiscal intermediaries (FIs). (Medicare administrative cntractrs, r MACs, replaced carriers and FIs in 2005.) Current Dental Terminlgy (CDT) Published by the American Dental Assciatin (ADA) Thrugh 2004, published as CDT-1, CDT-2, CDT-3, and CDT-4; in 2005, CDT published as an annual revisin (CDT-2005), similar t CPT. Classifies dental prcedures and services Dental prviders and ambulatry care settings use CDT t reprt prcedures and services. CDT cdes are als included in HCPCS Level II; they begin with the first digit f D. CDT als includes the Cde n Dental Prcedures and Nmenclature (Cde), instructins fr use f the Cde, questins and answers, ADA dental claim frm cmpletin instructins, and tth numbering systems. Natinal Drug Cdes (NDC) Published by a variety f vendrs, the cding system is in the public dmain Managed by the Fd and Drug Administratin (FDA) Originally established as part f an ut-f-hspital drug reimbursement prgram under Medicare Serves as a universal prduct identifier fr human drugs Current editin is limited t prescriptin drugs and a few selected ver-the-cunter (OTC) prducts Pharmacies use NDC t reprt pharmacy transactins. Sme heath care prfessinals als reprt NDC n claims. Medical Classificatin and Cding Systems, page 5

6 Cding System Descriptin Internatinal Classificatin f Primary Care (ICPC) Includes infrmatin abut new develpments in the cnceptual basis f understanding general and family practice Classificatin is based n the use f standard terminlgy as defined in the internatinal glssary published by the Wrld Organizatin f Natinal Clleges, Academies and Academic Assciatins f General Practitiners/Family Physicians (WONCA) Classificatin Cmmittee in 1995 Includes infrmatin abut a number f new initiatives related t classificatin, such as the Duke/WONCA severity f illness checklist, which enables either individual health prblems, r the cmbined health prblems f the patient, t be graded in terms f severity; COOP/WONCA functinal status assessment charts allw assessment f functinal status f the patient independent f any particular reasn fr the encunter r health prblem (COOP standards fr The Dartmuth Cperative Charts.) Alternative Billing Cdes (ABC cdes) Alternative Billing Cdes (ABC cdes) classify services nt included in the CPT manual t describe the service, supply, r therapy prvided; they may als be assigned t reprt nursing services and alternative medicine prfessins. Cdes are five characters in length, cnsisting f letters, and supplemented by 2-digit cde mdifiers t identify the practitiner perfrming the service. Fr example, during an ffice visit, an acupuncture physician assessed the health status f a new client and develped a treatment plan, a prcess that tk 45 minutes. ABC cde assigned: ACAAC-1C. (The ffice visit is cded as ACAAC, and the acupuncture physician is assigned mdifier 1C.) HIPAA authrized the Secretary f DHHS t permit exceptins frm HIPAA transactin and cde set standards t cmmercialize and evaluate prpsed mdificatins t thse standards; ABC cde set was granted that exceptin in 2003, and the cdes are being cmmercialized and evaluated thrugh Intent is fr ABC cdes t be adpted as part f the electrnic cde set (as HCPCS Level I and Level II were in 2000) Medical Classificatin and Cding Systems, page 6

7 Cding System Descriptin Health Insurance Prspective Payment System (HIPPS) rate cdes Clinical Care Classificatin (CCC) System Alpha-numeric cdes cnsisting f five digits Each HIPPS cde cntains intelligence, with certain psitins f the cde indicating the case mix grup itself and ther psitins prviding additinal infrmatin (e.g., infrmatin abut the clinical assessment used t arrive at the cde). Created as part f the prspective payment system fr skilled nursing facilities in 1998 Additinal HIPPS cdes were created fr ther prspective payment systems, including a system fr hme health agencies in Octber 2000 and ne fr inpatient rehabilitatin facilities in January Represent specific sets f patient characteristics (r casemix grups) n which payment determinatins are made under several prspective payment systems HIPPS cdes are nt assigned frm a cding manual; they are created when infrmatin fr a data set is entered int sftware. Fr example, the hme health prspective payment system (HHPPS) requires entry f the Outcme and Assessment Infrmatin Set (OASIS) data set int gruper sftware, which generates the 5-digit alphanumeric HIPPS cde that is entered n the UB-04 claim. Prvides a new standardized framewrk and a unique cding structure fr assessing, dcumenting, and classifying hme health and ambulatry care Previusly called the Hme Health Care Classificatin System (HHCC) Cnsists f tw interrelated taxnmies: CCC f Nursing Diagnses and CCC f Nursing Interventins classified by 21 care cmpnents that represent the functinal, health, behaviral, physilgical, and psychlgical patterns f patient care The 21 care cmpnents serve as a standardized framewrk fr mapping and linking the tw interrelated CCC taxnmies t each ther and t ther health-related classificatins, and they are used t track and measure patient/client care hlistically ver time, acrss settings, ppulatin grups, and gegraphic lcatins. Medical Classificatin and Cding Systems, page 7