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Comparison of ICD-10-AM Data Quality Between Jurisdictions, As Measured by PICQ 2002

Comparison of ICD-10-AM Data Quality Between Jurisdictions, As Measured by PICQ 2002. Authors: Catherine Perry Sue Wood Kirsten McKenzie Andrea Groom Kerry Innes. What is PICQ 2002?. A software package For reviewing ICD-10-AM coded data Identifies coding variation in dataset

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Comparison of ICD-10-AM Data Quality Between Jurisdictions, As Measured by PICQ 2002

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  1. Comparison of ICD-10-AM Data Quality Between Jurisdictions, As Measured by PICQ 2002 Authors: Catherine Perry Sue Wood Kirsten McKenzie Andrea Groom Kerry Innes

  2. What is PICQ 2002? • A software package • For reviewing ICD-10-AM coded data • Identifies coding variation in dataset • Contains • Over 100 indicators: Fatal, Warning, Relative • Denominator / Numerator • Denominator count = records looked at • Numerator count = records with problem

  3. Indicator Examples • Records with rehabilitation care type but PDx code not admission for rehab • Obstetric perineal laceration 1st/2nd degree without repair • Hyperglycaemia code with diabetes code • Diagnosis indicates death but separation mode is not death • External Cause code required but not present with a trauma code

  4. Aims of data analysis • Determine areas where there are coding issues • Highlight coding data quality issues of national significance (eg health priority areas) • Inform: • Coder education • Amendments to ICD-10-AM • Development of PICQ • Enhancements to current indicators • Indication as to what topics could be targeted for new indicators

  5. Data Analysed • AIHW Data ICD-10-AM Edition • 2000 Jan-Jun ICD-10-AM 1st Edition • 2000 Jul-Dec ICD-10-AM 2nd Edition • 2001-02 Fin. Year ICD-10-AM 2nd Edition • 2002-03 Fin. Year ICD-10-AM 3rd Edition

  6. Methodology and Limitations • Used PICQ 2002 Software • Exclusion of some indicators due to: • Data items not present in AIHW data • Problem since identified with individual PICQ indicators • Analysis of data: • Basic results from PICQ data • Also some significance testing of results in SPSS • Not yet received all data

  7. 1st edition to 2nd edition In the first 6 months of ICD-10-AM 2nd edition: 1 of 5 States improved their overall Fatal indicator rate 5 of 5 States improved their overall Warning indicator rate 2nd edition to 3rd edition In the first 12 months of ICD-10-AM 3rd edition: 3 of 5 States improved their overall Fatal indicator rate 4 of 5 States improved their overall Warning indicator rate Results: Changes between Editions of ICD-10-AM

  8. Results: Changes over time using ICD-10-AM 2nd Edition • Jul-Dec 2000 compared to 2001-02 • 4 of 5 States improved their overall Fatal indicator rate • State that did not improve went from having the 2nd highest rate in 2000, to a rate more than double any one else in 2001-02 • 4 of 5 States improve their overall Warning indicator rate • Less marked change than for Fatal indicators

  9. Comparison of fatal indicator error rates between jurisdictions

  10. Fatal Indicators with high rates • Indicator1st Ed2nd Ed3rd Ed • Jan-Jun 2000 2001/02 2002/03 • Secondary neoplasm site code without primary site code • 2.30 2.632.70 • Alzheimer's disease code without dementia code • 8.56 11.009.68 • Newborn affected by C/S w/out code indicating effect • 80.22 63.8942.32 • Type of spinal cord lesion w/out functional level of spinal cord lesion54.49 27.2126.41

  11. Comparison of warning indicator error rates between jurisdictions

  12. Warning Indicators with high rates • Indicator1st Ed2nd Ed3rd Ed • Jan-Jun 2000 2001/02 2002/03 • Cataract code as principal diagnosis before glaucoma code • 28.40 28.56 26.50 • Insertion of pacemaker code without insertion of electrode code 98.79 17.19 18.88 • Diabetes mellitus, non insulin-dependant, age <30 years • 19.22 19.50 23.25 • Respiratory distress of newborn unspecified • 21.20 18.67 15.43

  13. Relationship between Fatal and Warning Indicators

  14. What do the results say about coding quality in Australia? • Having a tool to measure the quality of coding has resulted in an overall improvement in these areas nationally • Using PICQ at a Health Department level, and feeding the results back to hospitals, results in improved data • That there is more work to be undertaken • Coding quality is not related to size of the jurisdiction

  15. Indicator rates are just a starting point! • Great PICQ indicator rates  great overall coding • Poor PICQ indicator rates  poor overall coding • May highlight: • Coders not following coding standards & conventions • Local coding practices • Classification issues • Documentation issues • Issues may be system related, rather than coder related

  16. Outcomes From PICQ Analysis • NCCH • Coder education (including in Coding Matters) • Development of ICD-10-AM 4th Edition • Development of PICQ • Jurisdictions • Raised interest in benchmarking • Provided information to support education • Increased desire for information that can be released to their Coding Committees

  17. Where to from here? • Further analysis • Feed information back to Coding Committees for consideration at a local level • Release of PICQ 2004 (for use with 4th edition codes) • 97 New indicators for 4th edition • 223 Total indicators for 4th edition

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