15/10/2014
Any questions from yesterday?
Australian Galah
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© 2014
Importance of consistent and
accurate Clinical Coding
PREPARED BY: ANNA COOTE & HEATHER GRAIN
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Objectives
• Understand the importance of consistency and
accuracy of Clinical Coding for DRGs, Casemix, ABF
• Understand the relevance of the Clinical Coders
Code of Ethics to consistency and accuracy
• Understand the differing (and often conflicting)
needs of Coding for:
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funding,
Clinical research,
clinical decision making
Management and planning
Understand the Clinical Coding audit process
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Code of Ethics for Clinical Coders
Provides guidance for Clinical Coders in
reflecting accurately the clinical characteristics
of patient and health service interventions
Enable clinicians and health care administrators
to understand the ethical obligations of Clinical
Coders.
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Code of Ethics for Clinical Coders
Code of Ethics for Clinical Coders
The National Centre for Classification in Health (NCCH) is an
Australian centre of expertise in classification of morbidity,
cause of death and health interventions. One of the Centre's
objectives is to develop and promote standards of coding
practice, including ethical practice.
This Code of Ethics has been developed by NCCH to provide
guidance for clinical coders in reflecting accurately the
clinical characteristics of patient and health service
interventions. Clinical data are used for research, monitoring
public health, and for the planning, evaluation and funding
of health services. The Code will also enable clinicians and
healthcare administrators to understand the ethical
obligations of coders.
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Code of Ethics for Clinical Coders
1.
2.
3.
Participate in quality improvement activities to ensure
that the quality of coding supports the use of data for
research, planning, evaluation and reimbursement, in
the spirit of mutual respect for colleagues.
Ensure all information necessary for abstraction and
coding processes is available.
Apply the Australian Coding Standards (ACS) and other
official reporting requirements for the purpose of:
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abstracting diagnoses and procedures using the
entire clinical record
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selecting and sequencing diagnosis and
procedure codes
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optimising reimbursement only when legitimate.
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Code of Ethics for Clinical Coders
4. Ensure that clinical record content
justifies selection of diagnoses and
procedures, consulting clinicians as
appropriate.
5. Participate in ongoing education to
ensure that skills and knowledge meet
the appropriate level of competence.
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Code of Ethics for Clinical Coders
8. Refuse to participate in or conceal illegal or
unethical processes or procedures.
6. Contribute to ongoing development of
classification systems in conjunction with
appropriate coding and clinical experts.
7. Observe policies and legal requirements
regarding confidentiality of patient related
clinical information.
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Ayres Rock
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Clinical Coder’s Creed
…clinical coders will often need to make decisions which
are based on their experience and common sense as
well as the resources available to them.
When you look at what clinical coders do objectively,
they assign numbers from a structured, classification
system to complex, ever-changing medical concepts
which are not documented in a standardised way – no
wonder it can be difficult!
To revisit the fundamental skills of the clinical coder:
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Clinical Coder’s Creed
To revisit the fundamental skills of the clinical
coder:
• A clinical coder has a thorough, working
knowledge of medical science and
terminology.
• A clinical coder can read the clinical record
and make decisions about the appropriate
codes to assign, based on the clinical
documentation.
• A clinical coder understands the structure
and use of a statistical classification.
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Clinical Coder’s Creed
Clinical Coders' Creed
These things are the fundamentals of the art and
science of clinical coding:
Clinical documentation
Communication with clinicians
Coding standards
Conventions
Classification experience
Common sense
sCience of medicine
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The Olgas
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What makes accurate coding?
• Abstracting – searching the medical record to find
all of the diagnoses and procedures meeting the
requirements of the ACS
• Assessing – that all documentation necessary for
complete coding is available
• Obtaining – missing information
• Choosing - the correct Principal Diagnosis and
Principal Procedure
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What makes accurate coding?
• Completely coding –all of the Diagnoses and
Procedures according to the ACS
• Sequencing – listing the diagnoses and
procedures in the correct order
• Data entering – ICD and ACHI codes, and
other relevant data
• Correcting – using Coder-Clinician queries
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Clinical Coding Audit
Camel racing in Alice Springs, Australia
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Clinical Coding auditors
Qualifications
Experience
Colleague auditing
Experienced external auditors
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Clinical Coding Audits
Educational not disciplinary
Clear aim – coding or DRGs?
• Automated
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Real time
After the event
• In house
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Regular
Qualified auditor OR coding staff
• Find the $ audits
• External
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Audit sample
• Random sample
• Targeted sample
• Use a health statistician
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Audit reports
• Percentage with DRG change
• Increase in weight
• Decrease in weight
• Types of error resulting in DRG change
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Clinical documentation
Choice of Principal diagnosis/procedure
Missed codes
Aust. Coding Standard error
Sequencing
Etc.
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Audits – educational not disciplinary
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The End….any questions?
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