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SSuN: Diagnostic coding. SSuN Call #4 Nov 6, 2008. Nov. 6 – Call Agenda. Diagnoses to capture in SSuN Cycle 2 File structure for collecting data System for coding diagnoses with minimum burden and changes to local systems Mapping local codes to a common system.
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SSuN: Diagnostic coding SSuN Call #4 Nov 6, 2008
Nov. 6 – Call Agenda • Diagnoses to capture in SSuN Cycle 2 • File structure for collecting data • System for coding diagnoses with minimum burden and changes to local systems • Mapping local codes to a common system
What Diagnoses to Capture? (1) • Syphilis • Primary, secondary, early latent, unknown latent, late latent, late with symptoms • Gonorrhea • Chlamydia • Genital Herpes • Genital Warts • Trichomoniasis • Nongonococcal Urethritis (NGU) • Muco-purulent cervicitis (MPC)
What Diagnoses to Capture? (2) • Pelvic Inflammatory Disease (PID) • Epididymitis • Chancroid • Lymphogranuloma venereum (LGV) • Granuloma Inguinale • Hepatitis • HepB acute, HepB chronic • HIV/AIDS • No STD diagnosed
What Diagnoses to Capture? (3) • Consider: • Bacterial vaginosis (BV) • Candidiasis • Scabies • Pediculosis • Contact to STD • Pregnancy • Normal exam/diagnosis • Other
Other Issues to Consider • How much specificity do we need? • Diagnostic file vs. lab file • Do we need anatomic site information in both files? • Any other diagnoses to consider?
STD clinic diagnostic coding File structure
Flat file vs. relational file Flat file structure Relational file structure
SSuN Cycle 1 Method • Relational Database • Lab data (test results) is linked by Event ID • Multiple events linked to 1 patient • Currently only collect: • GC test type • GC anatomic site • GC test result • Chlamydial co-infection
MSM Prevalence Monitoring Project Method • Flat file structure • Individual variables for each diagnosis • Often diagnosis variables incomplete and result variables are used • Currently collect test results for: • GC • CT • Syphilis • HIV
STD Clinic Lab file • One patient can have several different lab tests done at a single visit • One patient can have several different visits
STD Clinic diagnostic code file • One patient can have several diagnoses at a single visit
File Structure – Discussion Topics • Are there significant advantages to using the relational file structure? • More efficient use of space • More flexible to add diagnosis codes • What method do sites favor? • Flat vs. relational file structure
STD clinic diagnostic coding Coding options
What’s currently happening at the local level? • In house diagnostic codes (5 sites) • Some or all ICD-9 codes (3 sites) • Check box, yes/no for each diagnosis (3 sites) • Some or all universal codes from STD*MIS (3 sites)
Options for coding • ICD-9 codes (modified) • ICD-10 codes (modified) • Snomed Clinical Terms (CT) • Universal codes (e.g., STD*MIS) • Create new coding classifications • Individual variables for each diagnosis • Check box, yes/no
ICD-9 vs. ICD-10 ICD-9 ICD-10
Reasons to postpone using ICD-10 • Planned deadline for national transition is 2011 • Has not been piloted in U.S. • 68,000 codes • compared to 13,000 ICD-9 codes • No sites are currently using ICD-10 • Some use ICD-9 • American Academy of Family Physicians discourages use
SNOMED CT • What is it? • Input system as opposed to “output system” like ICD-9 or ICD-10 • Used for documentation of clinical care • Better if linked to a classification system • Disadvantages • Less than 30% of ICD-9 codes can be mapped to Snomed CT • Difficult to manually assign codes • Strings of digits in length 6-18 • No logic to string, unlike ICD-9
Advantages/Disadvantages to Universal Codes • Advantages: • Used in 3 sites • Less complex than ICD-9 or Snomed • Already standardized and collected at CDC • Disadvantages: • Might not be specific enough • Additional codes may be needed
Advantages/Disadvantages to Creating a New Coding System • Advantages: • Flexible • Wouldn’t require modification of an established coding system • Disadvantages: • Not based on a current system • More time to create and standardize • Issues with piloting
Individual Diagnosis Variables • One variable for each diagnosis • Check box, yes/no • Many variables • Longer record length • Not as easily modified
Coding System – Discussion Topics • A standardized/structured coding system would work best • Will have to modify coding system regardless of what we choose • Best options: • ICD-9? • STD*MIS universal codes? • Create new coding system? • What coding system do sites favor?
STD clinic diagnostic coding Mapping
Mapping Relationships • Many to one: • ICD-9 codes may be too specific • Need to collapse several codes into 1 code • One to many: • What if our codes are more specific than the sites collect? • How do we map a local site from one to many?
