Analysis of the Results of Morbidity Coding Pilot Tests

7/27/2019 Analysis of the Results of Morbidity Coding Pilot Tests

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Morbidit Codin Pilot Tests17th IFHIMA Congress

,

Joon Hong (Korea)

Marjorie Hendricks (Jamaica) Carol Lewis (US)

Samanthilaka Gamage (Sri Lanka)

Gemala Hatta (Indonesia)

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n n

Administration of pilot test in six countries ra e summary o p o exams

Characteristics of the scores

Responses of the examinees Findings

Problems identified

Lessons learned Decisions by WHO-FIC EIC for future action

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Pilot examination

Part Number Number Time*

Multiple choice 20 20(13.0) 20

Coding Dx 30 81(52.6) 90

Scenario 10 short

5 long

31 (34.4)

22

70

. .

Does not include time allotted to break and evaluation of questions3


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Administration of the pilot tests

Country Number Attribute

Korea 48 Hospital codersec urers n e co eges an un vers es

Japan 52 JHA distant training course lecturers

Designated universities lecturers

es gnate vocat ona sc oo ecturersHospital coders

Jamaica 25 Hospital coders

Sri Lanka 6 4 hospital coders(6.5 years coding experience)2 Medical record assistants

Sweden 26 Hospital coders29

Indonesia 105 92 coders, 12 instructors, 1 dentist4


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Country, examinees and results

p o mor y co ng exam na ons

-

Korea (Oct. 2010) 48 58.7

Ja an Jan. 2011 52 49.3

Jamaica (July 2011) 25 33.9

Sri Lanka (July 2011) 6 60.7

Sweden * (Sept. 2011

Nov. 2011)

26 55

29

53.4

n ones a ov. .

291 44.4 5


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Questions Percentage of correct answers

Korea Japan Jamaica Sri Lanka Indonesia

Multiple choice 65.0 71.0 45.6 66.7 44.6 79.3

Sweden

Coding Dx 58.6 49.5 34.2 66.0 30.2 46.9

cenar os . . . . .

Total test 58.7 49.3 33.9 60.7 31.4

.

53.4

Sweden followed a different testing protocol6


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very low scoresQuestion shown very low scores in 4 countries

Morbidity coding rule in Vol II

Coding instruction

Type of fractures included in open fracture

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Diagnosis coding questions shown very low scores

Question shown very low scores in 3 or 4 countries

Admission for chemotherapy, post oophorectomy

Adenocarcinoma of ilium

Pneumothorax with knife wound of chest wall

Essential hypertension and CHF8


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Missing or incorrect rate

y ype o co e, y coun ry

Korea Japan Jamaica Sri Lanka IndonesiaNumber %* Number %* Number %* Number %* Number %*

Incorrect or missing

External cause 283(73.7) 234(64.3) 117( 58.5) 20(41.7) 746(88.8)

Morphology 163(56.6) 178(57.1) 150(100.0) 10(27.8) 515(81.7)

** . . . .

Main condition 415(28.8) 615(39.4) 413( 55.1) 36(20.0) 1939(55.7)Incorrect selection 231(16.0) 314(20.1) 56( 7.5) 0( 0.0) 182( 5.8)

of main condition

g co e . . . . .

Over coding 49( 3.4) 73( 4.7) 23( 3.1) 3( 1.7)

4th digit code 198( 7.4) 131( 4.5) 121( 10.3) 14( 5.0) 664(10.7)

* Number of codes missing or incorrect x 100/the number ofmaximum applicable codes

** Total number of codes minus codes of Main condition, Morphology, and External cause

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Slide 9

cal1 Move the denominator up so that it follows the slashCarol; 15/04/2013


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Response of the Examinees

Difficulty of exam questionsNumber (%)

Korea Japan Jamaica

Difficult 37 ( 77.1) 36( 69.2) 9( 36.0)Intermediate 9 ( 18.8) 11( 21.2) 16( 64.0)

Easy 1 ( 2.1) 0( 0.0) 0( 0.0)

No answer 1 ( 2.1) 5( 9.6) 0 ( 0.0)48 (100.1) 52(100.0) 25 (100.0)

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Res onse of the Examinees

Time allocationKorea Japan Jamaica

Short 13( 27.1) 29( 55.8) 18( 72.0)

Intermediate 29( 60.4) 14( 26.9) 5( 20.0)Enough 4( 8.3) 2( 3.8) 2( 8.0)

No answer 2( 4.2) 7( 13.5) 0( 0.0)

Total 48(100.0) 52(100.0) 25(100.0)

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Res onse of the ExamineesClearness of the questions

Korea Japan Jamaica

Multiple choice(%)

Clear 837( 87.2) 20( 38.5) 228( 45.6)

Unclear 81( 9.6) 26( 50.0) 45( 9.0)

o answer . . .

Total 960*(100.0) 52(100.0) 500*(100.0)Scenario(%)

. . .

Unclear 89( 9.6) 24( 46.2) 25( 6.7)

No answer 70( 9.7) 6( 11.5) 179( 47.6)

Total 720*(100.0) 52(100.0) 375*( 99.9)

* Number of questions x number of examinees12


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. o eva ua e co ng s s

2. To know the pattern of questions of

international coding exam3. Out of curiosit

4. On the advice of others

.

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Comments by examinees A good experience and eye opening to a wide variety of diagnoses and

scenarios but more time is needed perhaps another half an hour

A ood measurin tool and should be continued and u raded on a

yearly basis to identify how much my coding skill is improving

All practicing coders should have the opportunity and experience to

.

A very good chance to know the personal level of coding and also tobenefit the country

coding and shown me that there is scope for improvement.

More coding workshops should be organized to get coders better- ,

better quality data after training!

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Findin s Need to reinforce coding education

Common areas which need codin education Correct use of combined codes

The meaning of and # mark in neoplasm table Correct assi nment of T code or Z code for com lication or

follow-up care of internal prosthetic device Assigning 4th and 5th digit code

Assigning additional and optional codes including externalcause co e an morp o ogy co e

Need to discuss the issues concerning the inclusion of

Morphology code External cause code with 5th digit

Additional/optional code15


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Importance of including certain

How important is it for coders to:Importance

Use an activity code when coding an

external cause 1 4 4 4

for all tumors 3 4 3 3 Use additional code if desired

whenever ICD includes this instruction 2 1 7 3

Recall meaning of each morbidity

coding rule (Volume 2) ** 1 - 4 7

Use a Z code to indicate outcome ofdelivery (Z37._) 2 2 4 5

Note: Response from 13 members of WHO-FIC EIC to selected questions

** 12 responses16


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Problems identified

Use of different versions of ICD-10 by countries,

an even w n e same coun ry, resu ng n

different codes for the same diagnosis

os or coun r es o a op e new vers onand translate it into their language

o ng w ou us ng - o .

Modified coding instructions that differ by countryan rom e n erna ona s an ar gu e nes

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Human and material resources and organization for

Translation of the exam questions when not done by

ICD-10

-

of the exam in the country administering the exam

Pur ose of the exam certification or assessment?

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Lessons learned

Good communication is essential

Exam protocol

Translation of the exam questions

Using same version of ICD-10 is required

m ng ma ers

Scheduling of exam

Time allotted to answering questions

More detailed coding instructions by WHO (Vol. 2) are required

Importance of identifying the weak points of morbidity coding for

developing/improving coding education program Poor test results can provide useful information

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Decisions by WHO-FIC EIC for future action

Maintain the development of exam to certify morbidity

coders as a long-term objective9 Continue to develop the exam to be available for individuals

to assess their own abilit ies, but not t ied to any certificationat present

9Continue the promotion of the exam

9 Continue collecting exam questions from many countries

ICD-11 when available

Explore development of an on-line exam for use with theweb-based training tool by WHO

Use existing questions for ICD-11 field trial20


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Thank you!

Carol - [email protected]

Joon [email protected]

Documents

Analysis of the Results of Morbidity Coding Pilot Tests