1 1 La actualización de la Codificación Clínica en Irlanda Updating Clinical Coding in Ireland El Camino hacia IDC-10 The Journey to ICD-10 Deirdre Murphy
2 2 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.
3 3 Hospital InPatient Enquiry (HIPE) Activity data on Inpatient and Day cases in all HIPE Public hospitals in Ireland. Each time a patient is discharged (or dies) this is a HIPE record to be coded.
4 4 HIPE Applications Clinical Research Service Planning Health Policy Epidemiology Casemix Consultant workload
5 Health Research and Information Division ESRI Contracted by Health Service Executive (HSE) to manage, collect and compile HIPE National Files 5 Supports and trains all clinical coders Responsible for timely and accurate national files HIPE software Provides national HIPE statistics
6 6 Discharge summary Coder extracts data from chart Patient discharged Training AUDIT Data onto HIPE system Validation Reporting HIPE National Database ESRI Monthly export to ESRI The HIPE Data Collection Process
7 7 Classifications used in Ireland to date: ICD ICD ICD-9-CM (Oct 88) ICD-9-CM (Oct 94) ICD-9-CM (Oct 98) OPCS Procedure classification ICD-10-AM (4 th Edition) ICD-10-AM (6 th Edition)
8 8 Coding in Ireland 250 coders including part-time and full time Nominated by hospitals from administration staff Approx 1.3m records from 60 hospitals A full time coder may code between records per year depending on experience & specialties.
9 9 Coding in Ireland Coders are supported at hospital level by the HIPE/Casemix coordinator (HCC). The ESRI provides training and support to all coders, HCCs and other personnel involved in coding in Ireland.
10 10 HIPE Coverage Over 96% coverage Data complete by 6 weeks of discharge Casualty and Outpatient data NOT collected
11 Clinical Coder Training 11 Basic Coding Course Module 1-2 days, Module 2-3 days (6 weeks later) Intermediate Coding Course 3 Days Specialty Workshops 1 Day Coding Refresher Course 3 Days Update courses IT courses
12 Clinical Coder Training 12 Specialty Workshops Clinical and coding information on specialty areas e.g. Neoplasms, Obstetrics and Gynaecology, Cardiology, Diabetes. Expert speaker to address the clinical aspects of the topic. Coders are invited to submit preferences
14 14 Continuing Education Hospital based training Regional workshops Hospital visits
15 15 Support Query Process Coding Queries Database of coding queries maintained Clinical advice available Up-to-date reference material maintained Published in Coding Notes
16 16 Data Quality Education on data quality initiatives for key personnel Coding Audit Toolkit Information on conducting data reviews Monitoring of queries issued Communication with hospitals Coding Standards
17 17 Data Quality- Audit Chart based Coding audits Scrutinising national data Training developments based on audit findings Local involvement in audit process Track & record all audit activity Training for audit role
18 18 Coding Notes New or amended guidelines New Codes I.T. Information Help and guidance Developments in HIPE Upcoming Courses Coding Queries Coding Features.
19 19 Coding Notes Issued to all involved in HIPE Available by All issues available on
20 20 HIPE Software Suite Windows HIPE Data Entry System Windows HIPE Reporter ICD-10-AM ebook Windows HIPE Batch Coder HIPE Audit Toolkit Windows HIPE Reference Viewer
21 21 HIPE Data entry software All HIPE records are keyed using the HIPE PC data entry system Validation checks Standard format Hospitals with PAS/HIS systems can download administrative fields
22 22 Tools W-HIPE data entry system W-HIPE Reporter Audit Local & National Training Courses Training Materials Selector Checks Roundtable meetings Coding Notes
23 23 ESRI Supports: Training Classification - Books W-HIPE - Data entry & Reporting software Audit Function Coding Notes & all support to help hospitals to provide data to the HIPE National DataBase Data Request function
24 24 Coders Roles Data Management Communication Quality Training Liaison Managing the Coding Team
25 25 Data Quality-National Level Data quality framework Edits Training of coders Clinical Classification & Coding Standards Coding query clearing house available to coders Chart-based audit
26 26 Data Quality-National Level Data quality framework Edits Training of coders Clinical Classification & Coding Standards Coding query clearing house available to coders Chart-based audit
27 27 Tools W-HIPE data entry system W-HIPE Reporter Audit Local & National Training Courses Training Materials Selector Checks Roundtable meetings Coding Notes
28 28 Reporter Tool Produce reports on hospital activity Routine quality control Used also at national level All hospitals receive queries and most are generated through Reporter checks
29 29 Audit Common Findings Quality of documentation Levels of clinician involvement Coder training Coding Issues Communication
30 30 Classifications used in Ireland to date: ICD-8 OPCS Procedure ICD-9 classification ICD-9-CM (Oct 88) ICD-9-CM (Oct 94) ICD-9-CM (Oct 98) ICD-10-AM (4 th Edition) ICD-10-AM (6 th Edition)
31 31 Updating Clinical Coding in Ireland: Options and Opportunities 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 (3 rd Edition)
32 32 What is needed from a Classification? Composite Coding Scheme Regular Updates Training and Support International Comparability
33 33 ICD-10-AM Composite Coding Scheme ICD-10-AM & ACHI Regular Updates Training and Support Biennial NCCH International Comparability Also Australian Coding Standards (Volume 5) ebook
34 34 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
35 35 Pilot of ICD-10-AM HIPE Unit, ESRI & 6 HIPE Hospitals December 2002 February 2003
36 36 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 guidelines than ever before.
37 37 The Pilot 474 charts coded 11 coders 6 hospitals
38 38 Pilot of ICD-10-AM HIPE Unit, ESRI December 2002 February PHASES IN THE PILOT Phase 1. HIPE Pilot Project team preparation Phase 2. Hospital and coders Data collection Phase 3. Data collation and analysis.
39 Pilot of ICD-10-AM 39 HIPE Unit, ESRI December 2002 February 2003 Phase 1 September November 2002 Interest volunteered by Irish hospitals Pilot site selection Resource acquirement Training and Education - HIPE Project Team
40 Pilot of ICD-10-AM 40 HIPE Unit, ESRI December 2002 February 2003 Phase 2 November 2002 January 2003 Training and Education - Pilot Hospital coders Hospital based exercise - Dual Coding study Data and feedback collection Group focus day
41 Pilot of ICD-10-AM 41 HIPE Unit, ESRI December 2002 February 2003 Phase 3 February April 2003 Compilation of pilot study sample data Data entry of coded cases Analysis & evaluation of pilot study Final report
42 Pilot of ICD-10-AM Sample result Table 20 - Procedures codes collected for Excision of Skin Lesion 42 ICD-10-AM CODE Procedure No ICD-9-CM CODE Procedure No Excision of lesion of skin and subcutaneous tissue of other site of head Other local excision or destruction of skin Excision of lesion of skin and subcutaneous tissue of other site Radical excision skin lesion Excision of lesion of skin and subcutaneous tissue of leg Excision of sinus of skin and subcutaneous tissue Extensive excision of skin and subcutaneous tissue for sycosis, from face or neck 1 Total 15 15
43 43 Pilot of ICD-10-AM Sample result 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 ICD-9-CM Code etc Procedure Injection antibiotic Routine chest X-ray Diagnostic ultrasound -head/neck Diagnostic ultrasound-heart Electrocardiogram Inject/infuse NEC Diagnostic ultrasound-urinary Electroencephalogram ECG monitoring.. Code Count
44 44 Summary Results of Pilot Chart documentation to improve. Adherence to coding guidelines mandatory. Medical terminology to be improved. Self education and responsibility for developing own skills vital for coders.
45 45 Summary Results of Pilot The commitment of coders and HCCs to support data quality initiatives is vital to HIPE. There is a need for renewed efforts to ensure compliance with national coding guidelines by all clinical coders.
46 46 Summary Results of Pilot ICD-10-AM could be: Used successfully by coders in Irish hospitals and was Acceptable to these coders.
47 47 ICD-10 ICD-10-AM There is no change in the structure of ICD-10 The meaning of the three character and four character codes in ICD-10 are not changed Any modifications are consistent with existing ICD-10 codes and conventions The ability to compare ICD-10-AM data with ICD-10 data over time is not compromised.
48 48 Features of ICD-10 maintained in Alphanumeric codes ICD-10-AM include: Inclusion of codes for post-procedural disorders at the end of each appropriate chapter A change of the axis for classifying injuries from type of injury in ICD-9-CM to body site in ICD-10 The use of Dagger and Asterisk Coding
49 49 Australian Coding Standards Volume 5 Coding conventions/definitions Clinical and coding information Indexed in Volume 1 and Volume 3 as appropriate. Coding Matters between editions of ICD-10-AM
50 50 E-Book for ICD-10-AM e-book 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.
54 54 Coding Matters Coding Matters is the quarterly newsletter of NCCH (Sydney). Any changes in practice are expected to be implemented by coders once they have been published in Coding Matters.
55 55 What s the same? Extraction of information from charts Selection of main term, ICD code and verification in tabular Definition of the Principal Diagnosis Guidelines e.g. Poisoning & Adverse effects Neoplasms
56 56 What s different? 5 books /E-Book Australian Coding Standards 7-digit codes for Procedures presented in blocks.
57 57 What s different? Secondary/additional diagnoses NCCH has tightened the definition of additional diagnoses to limit coding of conditions to only those that affect patient management in a significant way. An additional diagnosis should not be routinely coded just because a patient is on ongoing medication for treatment of this condition.
58 What s different? 58 Anaesthetics Anaesthetic codes are collected in ICD-10-AM when a procedure is performed. General Anaesthetic and Sedation are always coded Anaesthetic codes require a two-character extension,which represents the patient's ASA American Society of Anaesthesiologists) score.
59 59 What s different? Australian Coding Standard 0042 Procedures normally not coded lists procedures not coded because they are usually: routine in nature performed for most patients and/or can occur multiple times during an episode the resources used to perform these procedures are often reflected in the diagnosis or in an associated procedure.
60 60 Examples of procedures listed under ACS 0042 Procedures normally not coded: Application of plaster Dressings Drug treatment Echocardiogram Postprocedural urinary catheterisation Primary suture of surgical and traumatic wounds Ultrasound X-rays without contrast (plain)
61 61 Implementation In Ireland 2004 Introduce the Classification 2005 Working with the Classification
62 62 Training 2004 Coding Notes - March 2004 & following editions. A series of One Day workshops and introductory days held nationally in 2004
64 64 Preparation Advice Communicate with hospital staff Improve chart documentation Tackle Backlogs to cut down on the Dual Coding Period The Dual Coding Period
65 65 ICD-10-AM Training Australia 3 members of HIPE Data Quality and Training group from ESRI travelled to Australia in May Training 2 - Data Quality Train the trainer week in NCCH Sydney Attended 4 th Edition Update workshops
66 66 Initial stages April July 2004 W-HIPE data entry and reporting software amended Edits reviewed Liaison by phone and with NCCH Ordering of books/ebooks Organise Phase 1 training courses Web Page for ICD-10-AM on
67 67 Ireland Phase 1 Training given by ESRI Staff A series of 2-day introductory workshops were held across Ireland from August to December 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 April to June 2005 with a series of 1-day nationwide workshops to address any outstanding issues.
68 68 Coding Notes provided information on the implementation
69 69 Phase 1 - Two-day workshops 15 held nationwide Autumn sets of books available & ebooks Smaller groups for Introductory phase Evaluation forms for preparing January 2004 courses with NCCH
71 71 Phase 1 Two-day workshops Agenda Introduce the Classification Conventions used in ICD-10-AM Australian Coding Standards Principal diagnosis Additional Diagnoses Procedure Conventions for ICD-10-AM
72 72 Tools available at Phase 1 courses Workbooks Posters Exercises Access to books/ebooks Advise on Update
73 73 Other preparations for hospitals Tackle Backlogs Stabilize coding team Appoint Ten Team Leader Set up an Implementation Group
74 74 Phase 2 January 2005 Workshops held in January two NCCH trainers conducted four 2-day workshops. Each workshop had about 50 attendees. Dedicated separate training sessions on the ebook.
75 75 ICD-10-AM Training Phase 2 January 2005 with NCCH 1 course Galway Dublin 2courses Cork 1 course
76 76 Phase 3 - ESRI April to June Day workshops (11 nationwide) Coders had started to use ICD-10-AM
77 77 Phase 3 Sligo 1x course Midlands 1 x course NE 1 x courses West 1 x courses Galway Dublin Dublin 3x courses Midwest 1 x courses Cork SE x 1 course Cork 2 x courses
78 78 Impact of ICD-10-AM Develop and phase in new training Australian Coding Standards (ACS) Workshops throughout 2005 Irish Coding Standards developed to compliment the ACS
79 79 Impact of ICD-10-AM Coverage Audit Quality Review Training Review WHIPE Data Entry software Casemix
80 80 Impact of ICD-10-AM Coverage By end of April 2005 Over 85% of new year coded compared to same time last year for % of hospitals participating in HIPE had returned records for 2005.
81 81 Impact of ICD-10-AM Data Quality Work on the quality of ICD-10-AM coded data commenced early in An audit in February 2005 showed good compliance and understanding of ICD-10-AM. Ongoing reviews confirm quality is good.
82 82 Transition Coding Courses now all in ICD-10-AM Work on edits in W-HIPE ongoing ICD-9-CM phased out by end of 2005.
83 83 A successful implementation A focused 3-phased national training plan undertaken by the ESRI in collaboration with the NCCH in Sydney. Additional information has been provided regularly to coders through Coding Notes. The support of the Department of Health and Children, the hospitals, coders and HCCs is also acknowledged as crucial to the implementation.
84 84 Ongoing.. Ongoing timely and accurate HIPE data. Update to future editions ICD-10-AM Data Quality Framework Development of software Irish Coding Standards (ICS) Accreditation for coders
85 85 Irish Coding Standards (ICS) Irish Coding Standards have been developed to be used in conjunction with the Australian Coding Standards. Coders need to be familiar with ICS ICS are not indexed in the ICD-10-AM classification (coding books or e-book)
86 86 Future Directions ICD-10-AM Accreditation for Coders
87 87 Future Directions ICD-10-AM 7 th Edition NCCH contract runs to end July 2010 (publication 7 th Edition) Future of ICD-10-AM at NCCH unclear.
88 88 Accreditation for Coders Accreditation of clinical coder training provided by the ESRI. Technological advances for training opportunities Linkage to Grading & Pay to training. Workforce study
89 89 Accreditation for Coders Benefits to workforce more stable, skilled qualified, appropriately remunerated coders recognised clinical coding profession Benefits to system Coded data will be viewed as of higher quality.
91 91 For any further information Deirdre Murphy, Health Research and Information Division, ESRI
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