Introduction

1. Introduction Prof Ric Marshall OAM The University of Sydney.

2. What is clinical coding? Clinical coding enables the translation of diagnoses, interventions and other health problems from words into alpha numeric codes, which permits easy storage, retrieval and analysis of the data. Source: The Australian Coding Standards, Seventh Edition, National Centre for Classification in Health, The University of Sydney, Commonwealth Department of Health

3. ICD-10-AM and ACHI • ICD-10-AM is the ‘InternationalStatisticalClassification of Diseases and Related Health Problems’, ‘TenthRevision’, ‘AustralianModification. • ACHI is the ‘Australian Classification of Health Interventions’.

4. Where are ICD-10- AM and ACHI codes used? Importantly, these codes are NOT used when services are rendered… By general practitioners within their practices By outpatient clinics In a community health setting By community allied health professionals In specialist rooms By community pharmacy These services rely on MBS and PBS coding. Coding is a statutory requirement for certain health services. • Coding is assigned for every separation from a licensed bed in AUS hospitals; this includes day procedures and day rehabilitation. • Coding is assigned for any event where there is an admission to hospital. This is termed an ‘episode’. • Coding occurs in both public and private hospital inpatient settings.

5. Why are the codes used? The codes are some of the most valuable health data elements. They can be used for many purposes, including: • Epidemiological studies of disease • Trends • Predictive modeling / forecasting • Clinical research • Health services / interventions evaluation • Health services planning and design • Quality assurance activities • Reimbursement by health insurers for service provided to private patients • Casemix management • Utilisation review • Activity-based funding

6. ICD-10-AM code structures Definitions Examples Chapter 19: Injury, poisoning, and certain other consequences of external causes S32Fracture of lumbar spine and pelvis S32.0 Fracture of Lumbar vertebrae S32.03 Fracture of lumbar vertebrae. L3 level Chapter 2: Neoplasms (C00-D48) C18 Malignant neoplasm of colon C18.6 Descending colon • Chapter – is either a system of the body, special group chapters such as a type of disease • Block of categories – 3 character categories of common characteristics such as a physical site or condition. • Subcategories - Fourth and fifth digits that add specificity

7. So then…what is a DRG? Definition Example ADRG G60 Digestive malignancy DRG G60A Digestive Malignancy w/ catastrophic or severe complications DRG G60B Digestive malignancy W/o catastrophic or severe CC C18.6 bowel cancer • Diagnosis-related groups (DRGs) are a classification scheme which provides a clinically and statistically meaningful way of relating the types of cases treated in a hospital to the resources required by a hospital. • The Australian Refined Diagnosis Related Group (AR DRG) is derived from a range of data collected on admitted patients, including diagnosis and procedure information, classified using ICD-10-AM and ACHI. • DRGs are not allocated manually because of the complexity involved. • Specially designed software that assigns a DRG is called ‘grouper’ software.