ICD X dan ICD IX CM Hubungan Dengan Casemix

Nurul Akbar

Cytomegalovirus
Cytomegalo pneumonitis J17.1 Rp 3.963.479

Cytomegalo hepatitis K71.0 Rp. 4.572.840

Closure of external fistula of trachea

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

Closure of other fistula of trachea ICD 9 CM 31.73 Rp. 6.646.245

Outline
1. 2. 3. 4. 5. 6. 7. Apakah Klasifikasi Penyakit Kegunaan sistem klasifikasi Sejarah ICD ICD 10 ICD 9-CM Procedure Code ICD 9-CM : 2005 Procedure Code & Case-Mix

Apakah Klasifikasi Penyakit?

Penyakit diklasifikasikan atau di buat dalam grup yang kriterianya sudah ditentukan Contoh kriteria:
Etiologi Anatomi Umur patofisiologi Tanda dan gejala Prognosis

What is Clinical Coding?

the translation of medical terminology, as written by the clinician, to describe a patients complaint, problem, diagnosis, treatment or reason for seeking medical attention, into a coded format which is nationally and internationally recognised.
(NHS Information Authority, Clinical Coding Instruction Manual)

Why Clinicians Should Know About Disease Classification?

Different Classification System has different schemes to categorize diseases Understand Diagnosis Recognised by Classification System Improve Accuracy of Diagnosis in Database Supervise Coding work Reduce Coding Errors

Main Classifications
ICD-10
International Used to capture diagnostic clinical data

OPCS-4
UK specific Used to capture surgical interventions & procedures

Accuracy is reliant upon

The 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

Accurate and Complete Information

Complete diagnostic and procedural information is vital.
Hepatitis
K75.9 Inflammatory liver disease, unspecified

Acute Hepatitis
K72.0 Acute and subacute hepatic failure

Alcoholic Hepatitis
K70.1 Alcoholic Hepatitis

International Classification of Diseases (ICD)

ICD-9
Introduced by WHO in 1975 Version of ICD used the longest Diseases Classified into 17 Chapters
67 Major categories with 3 digit code 255 Detail categories with 4 digit code Two Supplementary Lists E-code: External Causes of Injury and Poisoning V-code: Factors Influencing Health Status and Contact with Health Services

International Classification of Diseases (ICD)

ICD-10
Supposed to replace ICD-9 in 1985 Introduced only in 1993
Delayed by 8 years Important factor causing the delay Development of digital version Use of Alpha-numeric code

Disease Classified into 21 Chapters

Additional 4 more Chapters from ICD-9 Arrange from A00 to Z99 Expansion of Chapters of Sign, Symptoms and Ill-defined Conditions

International Classification of Diseases (ICD)

ICD 9-CM
Clinical 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 modification ICD 9-CM 2005 = sixth edition

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

Disease Classification

ICD 10 Disease Classification:

ICD 10
-

Disease classified into 21 chapters Use of Alpha-numeric code One letter and three numbers Arrange 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 1

-

21 chapters Chapters I XVII : Diseases and morbid conditions Chapter XIX : injuries, poisoning and certain other consequences of external cause Chapter XVIII : symptoms, signs and abnormal clinical & laboratory findings, not elsewhere classified Chapter XX : External causes Chapter XXI : factors influencing health status and contact with health services

ICD 10 Disease Classification:

DAGGER () and ASTERISK (*) () underlying disease
(*) : The manifestation or complication E.g. A17.0 Tuberculous Meningitis (G01*) Tuberculosis of Meninges (Cerebral) (Spinal) Tuberculosis Leptomeningitis

ICD 10 Disease Classification:

FIFTH CHARACTER Chapter XII : anatomical site Chapter XIX : to indicate open and closed fractures, an intracranial, intrathoracic and intraabdominal injuries with or without open wound Chapter XX : to indicate the type of activity being undertaken at the time of the event

Steps for Coding:

1. Identify the diagnostic phrase to be coded 2. Decide the Lead term 3. Look up lead term in the Alphabetic index 4. Locate any modifiers 5. Check the code given in the index with

Tabular list 6. Check for Inclusion and Exclusion terms 7. Assign the code

Underline the lead term in each diagnostic statement:

1. Cirrhosis of Liver
2. Oedema of Brain

3. Tuberculous Meningitis
4. Hemolytic Anemia 5. Anoxia Brain Damage

6. Perforation Peptic Ulcer

7. Ectopic Pregnancy

8. Lupus Erythematous
9. Essential Hypertension 10. Fistula-in-ano

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*5 O03.9 I11.0 Z47.0 C50.0 M85403 K80.4 S21.9 X99.99 I08.0

Accuracy is reliant upon

The 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

Clinicians and Data Quality

The source documentation should:
Be accurate and complete Reflect the patients episode of care Avoid the use of abbreviations Be clear and detailed Recording is legible and in indelible ink

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

Procedure Classification

History
ICD 9 (1975)
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

History

ICD 9-CM (1978)

- Introduced by US (Commission of Professional & Hospital Activities)

3 volumes:
Volume 1 Diseases : TABULAR LIST Volume 2 Diseases : ALPHABETICAL LIST LIST

Volume 3 Procedures: TABULAR and ALPHABETICAL

ICD 9-CM Procedure Classification:

1. 2. 3. 4. 5. 6. 7.

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 Medicine Surgical procedures are group in rubrics 01-86 Non-surgical procedures are confined to rubrics 87-99 Structure of the classification is based on anatomy rather than surgical specialty. Numeric only Based on 2-digit structure with 2 decimal digits where necessary (expansion from 3 digits in ICD 9 to 4 digits in ICD 9-CM)

Definition
Operative procedure Non-Operative procedure

Operative procedure
An 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 procedure
Other 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 00.1 00.2 00.3 00.5 00.6 00.9

Therapeutic ultrasound Pharmaceuticals Intravascular imaging of blood vessels Computer assisted surgery [CAS] Other cardiovascular procedures Procedures on blood vessels Other procedures and intervention

New codes (114) Invalid codes (4) Revised code titles (15)
Revised others (???)

Steps for Coding:

1. Identify the diagnostic phrase to be coded 2. Decide the Lead term 3. Look up lead term in the Alphabetic index 4. Locate any modifiers 5. Check the code given in the index with

Tabular list 6. Check for Inclusion and Exclusion terms 7. Assign the code

Coding the Procedures (ICD 9 CM)

All SIGNIFICANT procedures should be listed. Include both diagnostic and therapeutic Include significant non-surgical or non-operative procedures for e.g. CT Scan, MRI
Code any procedure that:

All procedures done in OT All procedures done outside OT but require skilled staff and expensive equipment

Do not include
Nursing procedures Routine procedures Procedures that do not require specialised staff Procedures that do not require special equipment

Examples of procedure that can be excluded

Ordinary plain X-Rays Ward 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

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 Z02.6

C34.3 M80423 O65.2

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

S82.21 V03.1
Q25.7

D16.2 M9180/0
S00.2 W57.99

Underline the Lead Term

1.Lower segment caesarean section secondary to Fetal Distress

2.Mid forceps delivery with episiotomy 3.Herniotomy for indirect inguinal hernia 4.Ritual Circumcision 5.Computerized Tomography Scan of Brain

6.Total Abdominal Hysterectomy & Bilateral Salpingo-oophorectomy

7.Debridement of Sequestrum of Tibia 8.Termination of pregnancy by aspiration curettage 9.Ultrasonography Uterus 10.Closed reduction of fractured humerus

Case-Mix

DRG Coding

DRG Decision Tree

Case-Mix System
A type of Disease Classification System Relates types of cases treated with resources used
First Developed by Professor Bob Fetter and Jon Thompson from Yale University 1980 Called Diagnostic Related Groups (DRGs) 383 groups initially Latest Revision: 492 groups based on ICD-9 CM Use for Prospective payment under Medicare since 1983

Case-mix System
Use the following information to categorize diseases:
Diagnosis Severity of illness Age of patient Co-morbidity Procedures Complications

Penyakit diklasifikasikan atau di buat dalam grup yang kriterianya sudah ditentukan Contoh kriteria:
Etiologi Anatomi Umur patofisiologi Tanda dan gejala Prognosis

Use the following information to categorize diseases:

Diagnosis Severity of illness Age of patient Co-morbidity Procedures Complications

Case-mix in other countries

Australia
Australian National DRGs (AN-DRG) 1992 1993: Victoria used case-mix based funding 1994 : South Australia

United Kingdom
Health Care Resource Groups (HRGs)

Canada
Case-mix Groups (CMGs) Resource Intensity Weights (RIWS)

German
German version of DRG

Types of DRGs Classifications

Medicare DRGs Refined DRGs All Patient DRGs (AP-DRGs) All Patient Refined DRGs (APR-DRGs) International Refined DRGs (IR-DRGs)

International Refined DRGs (IR-DRGs)

International Refined DRGs (IR-DRGs)

The objectives of the IR-DRGs:
Develop a DRG system that can be modified to country specific coding systems (ICD-9, ICD-10, ICD-10-PCS,) Develop a baseline DRG structure that can be adapted to country clinical practice variations Provide International basis of comparison Provide severity levels (1,2,3) for clinical management of patient outcomes

International Refined DRGs (IR-DRGs)

Objectives
Develop a classification system that defines all age groups Develop a classification system that is comparable across different coding systems
Patients will be assigned to the same DRG regardless of the coding system Historical data can be compared

International Refined DRGs (IR-DRGs)- Version 2

Services Covered
Hospital In-patient Day Care Surgery Specialist Clinic Emergency Room General Out-patient Rehabilitation Chemotheraphy and Radiotherapy Mental Health Services and Procedures

Cover Inpatient, outpatient and Day Care Total DRGs: 1168

IR-DRG Version 2.0 6 Digit System

MDC
DRG TYPE

BASE DRG

SEVERITY

Never underestimate the power of wrong Clinical Code

Training & Education

Audit/Trainer Coding Certificate

Speciality Workshops

Refresher Workshops Foundation Training

Foundation Modules
CONTENT
Medical terminology Anatomy & Physiology ICD-10 ICD-9 CM

Foundation Modules
3 modules 14 days Assessments

Refresher Workshop
Anatomy & Physiology ICD-10 ICD-9 CM Case studies

Refresher Workshop
3 days Cover Essential pointers Case studies When to attend

Specialty Workshops from

Obstetrics

CardioVascular

Regional workshops
Workshops: Orthopaedics Neoplasms Renal

Specialty Workshops
Cover both ICD-10 & ICD-9 CM Clinical input

Case studies

Additional Workshops
Audit
Beginners & Advanced

Train the trainer

Who else requires training/awareness

Clinicians Finance Departments Information Departments Clinical Governance DOH Analysts

Trainers
Who makes the best trainer

Individuals with strong subject matter Individuals versed in adult learning

Clinicians and Data Quality

The source documentation should:
Be accurate and complete Reflect the patients episode of care Avoid the use of abbreviations Be clear and detailed Recording is legible and in indelible ink