Pengenalan Kepada ICD X dan ICD IX CM

Nutrul Akbar

CytomegalovirusCytomegalo pneumonitis J17.1 Rp 3.963.479

Cytomegalo hepatitis K71.0 Rp. 4.572.840

Closure of external fistula of tracheaClosure of external fistula of trachea ICD 9 CM 31.72 Rp. 3.444.710

Closure of other fistula of tracheaICD 9 CM 31.73 Rp. 6.646.245

OutlineApakah Klasifikasi PenyakitKegunaan sistem klasifikasiSejarah ICDICD 10 ICD 9-CM Procedure CodeICD 9-CM : 2005Procedure Code & Case-Mix

Apakah Klasifikasi Penyakit?Penyakit diklasifikasikan atau di buat dalam grup yang kriterianya sudah ditentukan Contoh kriteria:EtiologiAnatomiUmurpatofisiologiTanda dan gejalaPrognosis

Purpose of Classification SystemEpidemiological NeedsComparisonsTime, Place, PersonsCase definitionsDuring outbreaksIn research (risk factors)Measure burdens of diseaseIncidencePrevalence

Purpose of Classification SystemPlanning and ManagementQuality assurance programmeWaiting timeRe-admission ratePost-operative complicationsRe-open rateEffectiveness of careCure ratesMortality ratesResource AllocationsCost per episode of careCost per dayCost per procedure

Why Clinicians Should Know About Disease Classification?Different Classification System has different schemes to categorize diseasesUnderstand Diagnosis Recognised by Classification SystemImprove Accuracy of Diagnosis in DatabaseSupervise Coding work Reduce Coding Errors

International Classification of Diseases (ICD)First developed by International Statistical CongressWilliam Farr: 1855Medical Statistician with General Registrar Office of England & WalesFarrs classificationDiseases classified under five groupsEpidemic diseasesConstitutional (general ) diseasesLocal diseases (arranged according to anatomical site)Developmental diseasesDiseases that are directly related to violence

International Classification of Diseases (ICD)ICD-1First version of ICD seriesInternational Statistical Congress139 Categories of DiseasesRevised up to version 5

International Classification of Diseases (ICD)ICD-6Taken over by WHO in 1948Consists of 3 ListsList A: Intermediate List of 150 diseasesList B: Abbreviated List of 50 diseasesList C: Special List of 50 diseases for social security purposes Revised every 10 years

International Classification of Diseases (ICD)ICD-9Introduced by WHO in 1975Version of ICD used the longest Diseases Classified into 17 Chapters67 Major categories with 3 digit code255 Detail categories with 4 digit codeTwo Supplementary ListsE-code: External Causes of Injury and PoisoningV-code: Factors Influencing Health Status and Contact with Health Services

International Classification of Diseases (ICD)ICD-10Supposed to replace ICD-9 in 1985Introduced only in 1993Delayed by 8 yearsImportant factor causing the delayDevelopment of digital versionUse of Alpha-numeric codeDisease Classified into 21 ChaptersAdditional 4 more Chapters from ICD-9Arrange from A00 to Z99Expansion of Chapters of Sign, Symptoms and Ill-defined Conditions

International Classification of Diseases (ICD)ICD 9-CMClinical modification of ICD 9 (WHO)Published by US government Designed for classification of morbidity and mortality information for statistical purposes.Disease and operations (Vol. I,II,III) Annual modificationICD 9-CM 2005 = sixth edition

Overview of The International Classification of Diseases, 10th Revision (ICD 10)Disease Classification

ICD 10 Disease Classification:ICD 10Disease classified into 21 chaptersUse of Alpha-numeric codeOne letter and three numbersArrange from A00 to Z99

ICD 10 Disease Classification: Three volumes - Vol. 1 : Tabular list - Vol. 2 : Instruction manual - Vol. 3 : Alphabetical index

ICD 10 Disease Classification: VOLUME 121 chaptersChapters I XVII : Diseases and morbid conditionsChapter XIX : injuries, poisoning and certain other consequences of external causeChapter XVIII : symptoms, signs and abnormal clinical & laboratory findings, not elsewhere classifiedChapter XX : External causesChapter XXI : factors influencing health status and contact with health services

ICD 10 Disease Classification:DAGGER (t) and ASTERISK (*)Dagger (t) : The underlying diseaseAsterisk (*) : The manifestation or complicationE.g.A17.0t Tuberculous Meningitis (G01*) Tuberculosis of Meninges (Cerebral) (Spinal) Tuberculosis Leptomeningitis

ICD 10 Disease Classification:FIFTH CHARACTERChapter XII : anatomical siteChapter XIX : to indicate open and closed fractures, an intracranial, intrathoracic and intraabdominal injuries with or without open woundChapter XX : to indicate the type of activity being undertaken at the time of the event

Steps for Coding:Identify the diagnostic phrase to be codedDecide the Lead termLook up lead term in the Alphabetic indexLocate any modifiersCheck the code given in the index with Tabular listCheck for Inclusion and Exclusion termsAssign the code

Underline the lead term in each diagnostic statement: 10. Fistula-in-ano 1. Cirrhosis of Liver2. Oedema of Brain3. Tuberculous Meningitis4. Hemolytic Anemia5. Anoxia Brain Damage6. Perforation Peptic Ulcer7. Ectopic Pregnancy8. Lupus Erythematous9. Essential Hypertension

Underline the lead term in each diagnostic statement: 20. Psychopathic Personality 11. Cleft Palate12. Fracture of neck of Femur13. Brights Disease14. Exfoliative Dermatitis15. Prostatic Hypertrophy16. Urethral Stricture17. Supervision of Normal Pregnancy18. Abscess of Brain19. Hydrocephalus in Newborn

Write the code for the following diagnoses: 1.Tuberculosis Arthritis of Hip 2.Spontaneous Abortion

3.Congestive Cardiac Failure with Hypertension

4.Removal of Smith Peterson Pin from Healed Fracture of Femur

5.Pagets Disease of Nipple

6.Calculus of Bile Duct, Acute Cholecystitis

7.Laceration of Chest attacked by a man with knife 8.Mitral and Aortic Incompetence With Chronic Rheumatic Heart Disease

A18.0+ M01.1*5O03.9I11.0Z47.0C50.0 M85403K80.4S21.9 X99.99I08.0

Write the code for the following diagnoses: 9. Complete Medical Check-up for Insurance purposes no abnormality detected

10.Oat Cell Carcinoma, Left Lower Lobe of Lung 11.Obstructed Labour due to Inlet Contraction Of Pelvis

12.Compound Fracture of Tibia. Pedestrian hit by a car

13.Congenital Pulmonary Aneurysm

14.Osteoma of the Tibia

15.Insect Bite on Eyelid

Z02.6C34.3 M80423O65.2S82.21 V03.1Q25.7D16.2 M9180/0S00.2 W57.99

Accuracy is reliant uponThe Clinician providing the information on the patients diagnoses and treatment

The Clinical Coder translating that information into the appropriate coded format to reflect the patients hospital stay

Complete diagnostic and procedural information is vital.

HepatitisK75.9 Inflammatory liver disease, unspecifiedAcute HepatitisK72.0 Acute and subacute hepatic failureAlcoholic HepatitisK70.1 Alcoholic Hepatitis

Accurate and Complete Information

Clinicians and Data QualityThe source documentation should:Be accurate and completeReflect the patients episode of careAvoid the use of abbreviationsBe clear and detailedRecording is legible and in indelible ink

Overview of The International Classification of Diseases, 9th Revision, Clinical Modification (ICD 9-CM)Procedure Classification

History Volume 1 Tabular List E Code supplementary classification of external causes of Injury and Poisoning V Code supplementary classification of Factors Influencing Health Status and Contact with Health Services Volume 2 Alphabetic Index ICD 9 (1975)

History- Introduced by US (Commission of Professional & Hospital Activities)ICD 9-CM (1978)Volume 2 Diseases : ALPHABETICAL LIST3 volumes:Volume 1 Diseases : TABULAR LISTVolume 3 Procedures: TABULAR and ALPHABETICAL LIST

ICD 9-CM Procedure Classification:Published in its own volume containing both Tabular List and Alphabetic Index.Modification of Fascicle V Surgical Procedures of ICD 9 Classification of Procedures in MedicineSurgical procedures are group in rubrics 01-86Non-surgical procedures are confined to rubrics 87-99Structure of the classification is based on anatomy rather than surgical specialty.Numeric onlyBased on 2-digit structure with 2 decimal digits where necessary (expansion from 3 digits in ICD 9 to 4 digits in ICD 9-CM)

DefinitionOperative procedure

Non-Operative procedure

Operative procedureAn operation - defined as any therapeutic or major diagnostic procedure which involves the use of instruments or the manipulation of part or parts of the body and generally takes place under O.T conditions. Any procedure undertaken in the O.T and/or under G.A, other than the normal delivery of an obstetric patient, is to be included. Principle Operation performed to treat the condition selected as the principle diagnosis

Non-Operative procedureOther investigative and therapeutic procedures which does not involves operation such as radiological, laboratory, physical, psychological and other procedures.

ICD-9-CM 2005 Procedure New chapter (1)0. PROCEDURES & INTERVENTIONS , NEC (00)00.0 Therapeutic ultrasound00.1 Pharmaceuticals00.2 Intravascular imaging of blood vessels00.3 Computer assisted surgery [CAS]00.5 Other cardiovascular procedures00.6 Procedures on blood vessels00.9 Other procedures and intervention New codes (114) Invalid codes (4) Revised code titles (15) Revised others (???)

ICD-9-CM 2005

Coding the Procedures (ICD 9 CM)All SIGNIFICANT procedures should be listed.Include both diagnostic and therapeuticInclude significant non-surgical or non-operative procedures for e.g. CT Scan, MRI

All procedures done outside OT but require skilled staff and expensive equipmentCode any procedure that: All procedures done in OT

Do not include Nursing proceduresRoutine proceduresProcedures that do not require specialised staffProcedures that do not require special equipment

Examples of procedure that can be excluded

Ordinary plain X-RaysWard catheterization;Cardiopulmonary resuscitation;Transfusion of blood UNLESS it was the reason for admission;Cardiac massage;Medication UNLESS psychiatric or cytotoxic;Laboratory tests or procedures;IV Therapy unless for dehydration;Anesthetic UNLESS for pain relief;Adjunct treatment such as physiotherapy

Steps for Coding:Identify the diagnostic phrase to be codedDecide the Lead termLook up lead term in the Alphabetic indexLocate any modifiersCheck the code given in the index with Tabular listCheck for Inclusion and Exclusion termsAssign the code

Underline the Lead Term 1.Lower segment caesarean section secondary to Fetal Distress2.Mid forceps delivery with episiotomy3.Herniotomy for indirect inguinal hernia4.Ritual Circumcision5.Computerized Tomography Scan of Brain6.Total Abdominal Hysterectomy & Bilateral Salpingo-oophorectomy7.Debridement of Sequestrum of Tibia8.Termination of pregnancy by aspiration curettage9.Ultrasonography Uterus10.Closed reduction of fractured humerus

Case-MixDRG Coding

Case-Mix takes into account:Diagnosis - primary -secondaryCo-morbiditiesComplicationsAgeSexSeverity

Procedures - primary - secondaryTreatmentMedicationsX-ray, LabsLength of stayComplicationsCo-morbidities

Clinical pathwaysResourcesClinical characteristics

DRG Decision Tree

Throwing Money Away (1) = $A795.00A 26 year old patient admitted for treatment of a compound fracture of the radius and ulna, upper proximal epiphysis. Fracture treated by an open wound reduction with internal fixation.The responsible doctor records the diagnosis and treatment as:Fracture of Arm + ReductionBecause of the lack of detail the episode would be coded with:T100 poorly defined fracture of upper limb, elbow, forearm4736300 Closed reduction of fracture without internal fixation, arm, NOSThe resulting AR-DRG assignment is: DRG I75 Average length of stay 1.8400 daysIncome per patient = Cost weight 0.5300 x Benchmark price (say $A1,500.00)

Throwing Money Away (2)

Average length of stay 2.7700 daysIncome per patient = Cost weight 1.1700 x Benchmark price (say $A1,500.00) = $A1,755.00

Recording the diagnosis and procedure accurately will result in . S528 Fracture, radius with ulna, upper end (any part) 9054101Open reduction, separated epiphysis, radius and ulnaThe resulting AR-DRG assignment is: DRG I19ZAn income INCREASE of $950.

Throwing Money Away (3)Example 2The effect of not coding or not correctly coding the surgical procedure(s).

Bad coding = lost income

Accuracy of data (1)Acute Myocardial Infarction: Total Cost (RM)

DRGMeanMinMaxALOS(Days)0533112,1106,19517,5794.60533219,69015,82723,5545.20533326,93023,35429,5068.6

Never underestimate the power of wrong Clinical Code

Training & Education

The Coders RoleRecommendation 151 - Kennedy Report

.competent staff, trained in clinical coding, and supported in their work are required: the status, training and professional qualifications of clinical coding staff should be improved.

Speciality WorkshopsCoding CertificateFoundation TrainingRefresher WorkshopsAudit/Trainer

Foundation ModulesCONTENTMedical terminologyAnatomy & PhysiologyICD-10ICD-9 CM

Foundation Modules3 modules

14 days

Assessments

Refresher WorkshopAnatomy & PhysiologyICD-10ICD-9 CMCase studies

Refresher Workshop3 days

Cover Essential pointers

Case studies

When to attend

Specialty Workshops from NHSIAObstetrics

Cardio-Vascular

Specialty WorkshopsCover both ICD-10 & ICD-9 CMClinical input

Case studies

National Clinical Coding Qualification (UK) Workshop2 daysMock exam4 step coding processHow to studyDiscussion

Additional WorkshopsAuditBeginners & Advanced

Train the trainer

Who else requires training/awarenessCliniciansFinance DepartmentsInformation DepartmentsClinical GovernanceDOHAnalysts

Who are the trainersNHSIA trainers

Regional tutors

Hospital based trainers

TrainersWho makes the best trainer

Individuals with strong subject matterIndividuals versed in adult learning

Trained coders role

The Trained Coders RoleStandardisation of information

Application of coding rules

Timeliness of data

Monitoring of quality of information

Clinicians and Data QualityThe source documentation should:Be accurate and completeReflect the patients episode of careAvoid the use of abbreviationsBe clear and detailedRecording is legible and in indelible ink

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Presenter notes Important points to communicate Explain that the coding accuracy is dependent upon two sets of staff. The clinical side providing the information The coding side translating the medical terminology

Explain that it is vital that the Clinical Coding Department have accurate information as it can make a large difference to the codingFor example:If the Clinicians just writes Hepatitis we would simply code it to K75.9 Inflammatory liver disease, unspecifiedIf the Clinicians add in the word acute we code it more accurately to K72.0 Acute and subacute hepatic failureIf the Clinicians state it was alcoholic we would code it to K70.1 Alcoholic Hepatitis

Explain that the same principle applies to procedures e.g. Colectomy, Sigmoid colectomy State that Clinical Coding is a complex skill and that it is not just simply about assigning a code to a term.Presenters Notes Important points to communicateDiscuss the source documentation that is used in your hospitalThe clinical coding is dependant upon the clinical staff detailing accurate and complete and legible information within the source documentation.

Clinicians are becoming more and more involved in the process of collecting clinical information. In the past they were responsible for writing in the casenotes but the future is the recording of all the relevant information on computer. This process is called terming. This is because it is not intended that a code is used to record the information, but natural clinical language or a clinical term.In the acute sector there are staff called clinical coders. Their job is to translate what is written in the casenotes into codes from the clinical classifications ICD-10 and OPCS-4. It is not a simple job and requires a considerable amount of skill. This job is called coding or classifying.Other members of staff, those dreaded and much maligned managers also have a process that they apply to clinical information in order to make it more useful to them. They do not require very specific details about patients but are interested in the financial implications of the diagnoses, procedures and length of stay. The process they use to give them figures about these factors is called grouping.Most of you would agree that in an ideal world what is needed are individuals who are competent in both. = Often we have to compromise

A study (American society for training and development) has concluded that 92% of training delivered results from the trainers generic training skills body language/voice/ manner) and only 8% from actual content BUT only 2 out of ten trainers have a formal background in training and 1 out of 10 receives regular personal development in their generic training skillsI said earlier that coding is a skilled job. It takes training to teach someone how to use the clinical classifications fully and properly. It is only by the consistent application of rules to the information that we can compare information that is generated by all the different organisations that make up the NHS. As more and more clinicians enter their own clinical data within the structure of an electronic health record, the role of the coder will become one of monitoring and auditing the quality of that data in order that the information is consistently produced to national standards - this includes correct sequencing of the data, filtering out irrelevant diagnoses that have no bearing on the current episode and selecting the relevant complications and comorbidities.There is now a national clinical coding examination that coders can take in order to become an accredited clinical coder. This covers clinical coders in England, Scotland, Northern Ireland and Wales and has the benefits of:providing recognition of the clinical coding professiongiving organisations confidence in their data quality and in the recruitment and ongoing assessment of clinical coding staffproviding a recognised benchmark

Presenters Notes Important points to communicateDiscuss the source documentation that is used in your hospitalThe clinical coding is dependant upon the clinical staff detailing accurate and complete and legible information within the source documentation.