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ICD X dan ICD IX CM

Hubungan Dengan Casemix

Nurul Akbar

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Cytomegalovirus

Cytomegalo pneumonitis J17.1Rp 3.963.479

Cytomegalo hepatitis K71.0

Rp. 4.572.840

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Closure of external fistula oftrachea

Closure of external fistula of tracheaICD 9 CM 31.72 Rp. 3.444.710

Closure of other fistula of tracheaICD 9 CM 31.73 Rp. 6.646.245

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Apakah Klasifikasi

Penyakit ?Penyakit diklasifikasikan atau di buat dalamgrup yang kriterianya sudah ditentukanContoh kriteria: Etiologi Anatomi

Umur patofisiologi Tanda dan gejala

Prognosis

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What is ClinicalCoding?

the translation of medical

terminology , as written by theclinician, to describe a patientscomplaint, problem, diagnosis,treatment or reason for seekingmedical attention, into a codedformat which is nationally andinternationally recognised .

(NHS Information Authority, Clinical Coding Instruction Manual)

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Why Clinicians Should Know

About Disease Classification?Different Classification System has differentschemes to categorize diseases

Understand Diagnosis Recognised byClassification SystemImprove Accuracy of Diagnosis in Database

Supervise Coding workReduce Coding Errors

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Main Classifications

ICD-10

International Used to capture diagnostic clinicaldata

OPCS-4 UK specific Used to capture surgical interventions

& procedures

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Accuracy is reliant

upon The Clinician providing theinformation on the patientsdiagnoses and treatment

The Clinical Coder translating thatinformation into the appropriatecoded format to reflect the patientshospital stay

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Complete diagnostic and proceduralinformation is vital.

HepatitisK75.9 Inflammatory liver disease, unspecified

Acute HepatitisK72.0 Acute and subacute hepatic failure

Alcoholic HepatitisK70.1 Alcoholic Hepatitis

Accurate and Complete

Information

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International Classification of Diseases(ICD)

ICD-9Introduced by WHO in 1975Version of ICD used the longestDiseases 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 andPoisoningV-code: Factors Influencing Health Statusand Contact with Health Services

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ICD-10Supposed to replace ICD-9 in 1985Introduced only in 1993

Delayed by 8 years Important factor causing the delay

Development of digital versionUse 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

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ICD 9-CMClinical modification of ICD 9 (WHO)

Published by US governmentDesigned for classification of morbidityand mortality information for statistical

purposes.Disease and operations (Vol. I,II,III)Annual modificationICD 9-CM 2005 = sixth edition

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Overview of

The International Classificationof Diseases, 10 th Revision (ICD 10)

Disease Classification

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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

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Three volumes- Vol. 1 : Tabular list- Vol. 2 : Instruction

manual

- Vol. 3 : Alphabeticalindex

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VOLUME 1- 21 chapters- Chapters I XVII : Diseases and morbid conditions

- Chapter XIX : injuries, poisoning and certain otherconsequences of external cause

- Chapter XVIII : symptoms, signs and abnormalclinical & laboratory findings, not elsewhereclassified

- Chapter XX : External causes- Chapter XXI : factors influencing health status and

contact with health services

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DAGGER ( ) and ASTERISK (*)() underlying disease(*) : The manifestation or complication

E.g.A17.0 Tuberculous Meningitis (G01*)

Tuberculosis of Meninges(Cerebral) (Spinal)

Tuberculosis Leptomeningitis

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FIFTH CHARACTER

Chapter XII : anatomical siteChapter XIX : to indicate open and closed

fractures, an intracranial, intrathoracicand intraabdominal injuries with orwithout open wound

Chapter XX : to indicate the type of activity being undertaken at the time of the event

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Steps for Coding:

1. Identify the diagnostic phrase to be coded2. Decide the Lead term3. Look up lead term in the Alphabetic index4. Locate any modifiers5. Check the code given in the index with

Tabular list6. Check for Inclusion and Exclusion terms7. Assign the code

U d li th l d t i h di g ti

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Underline the lead term in each diagnostic

statement:

10. Fistula-in-ano

1. Cirrhosis of Liver2. 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

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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 fromHealed 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

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Accuracy is reliantupon

The Clinician providing theinformation on the patientsdiagnoses and treatment

The Clinical Coder translating thatinformation into the appropriatecoded format to reflect the patientshospital stay

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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

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Overview ofThe International Classification

of Diseases, 9th

Revision, ClinicalModification (ICD 9-CM)

Procedure Classification

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History

Volume 1 Tabular List

E Code supplementary classification ofexternal causes of Injury andPoisoning

V Code supplementary classification ofFactors Influencing Health Statusand Contact with Health Services

Volume 2 Alphabetic Index

ICD 9 (1975)

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ICD 9-CM Procedure Classification:

1. Published in its own volume containing both Tabular List andAlphabetic Index .

2. Modification of Fascicle V Surgical Procedures of ICD 9Classification of Procedures in Medicine

3. Surgical procedures are group in rubrics 01-864. Non-surgical procedures are confined to rubrics 87-995. Structure of the classification is based on anatomy rather than

surgical specialty.

6. Numeric only7. 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)

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Definition

Operative procedure

Non-Operative procedure

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Non-Operativeprocedure

Other investigative and therapeutic procedures

which does not involves operation such asradiological, laboratory, physical,

psychological and other procedures.

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ICD-9-CM 2005 Procedure

New chapter (1)0. PROCEDURES & INTERVENTIONS , NEC (00)00.0 Therapeutic ultrasound00.1 Pharmaceuticals00.2 Intravascular imaging of blood vessels00.3 Computer assisted surgery [CAS]00.5 Other cardiovascular procedures00.6 Procedures on blood vessels00.9 Other procedures and intervention

New codes (114)

Invalid codes (4)Revised code titles (15)

Revised others (???)

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Steps for Coding:

1. Identify the diagnostic phrase to be coded2. Decide the Lead term3. Look up lead term in the Alphabetic index4. Locate any modifiers5. Check the code given in the index with

Tabular list6. Check for Inclusion and Exclusion terms7. Assign the code

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All SIGNIFICANT procedures should belisted .Include both diagnostic andtherapeuticInclude significant non-surgical ornon-operative procedures for e.g. CTScan, MRI

Coding the P rocedures (ICD 9CM)

All procedures done outside OT but requireskilled staff and expensive equipment

Code any procedure that:

All procedures done in OT

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Do not include

Nursing proceduresRoutine procedures

Procedures that do not require specialisedstaffProcedures that do not require specialequipment

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Examples of procedure that can beexcluded

Ordinary plain X-RaysWard catheterization;Cardiopulmonary resuscitation;

Transfusion of blood UNLESS it was thereason 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


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9. Complete Medical Check-up forInsurance purposes no abnormality detected

10.Oat Cell Carcinoma, Left Lower Lobe of Lung

11.Obstructed Labour due to Inlet ContractionOf Pelvis

12.Compound Fracture of Tibia. Pedestrian hitby a car

13.Congenital Pulmonary Aneurysm

14.Osteoma of the Tibia

15.Insect Bite on Eyelid

Z02.6

C34.3 M80423

O65.2

S82.21 V03.1

Q25.7

D16.2 M9180/0

S00.2 W57.99

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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 curettage9.Ultrasonography Uterus

10.Closed reduction of fractured humerus

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Case-Mix

DRGCoding

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DRG Decision Tree

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Case-Mix System

A type of Disease Classification SystemRelates types of cases treated with resourcesused 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

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Case-mix System

Use the following information to categorizediseases:

Diagnosis

Severity of illness Age of patientCo-morbidityProceduresComplications

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Penyakit diklasifikasikanatau di buat dalam grupyang kriterianya sudahditentukan

Contoh kriteria: Etiologi Anatomi Umur

patofisiologi Tanda dan gejala Prognosis

Use the followinginformation to categorizediseases:

DiagnosisSeverity of illness

Age of patient

Co-morbidityProceduresComplications

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Case-mix in other countries

Australia Australian National DRGs (AN-DRG) 1992 1993: Victoria used case-mix based funding 1994 : South AustraliaUnited Kingdom Health Care Resource Groups (HRGs)

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

German version of DRG

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International Refined DRGs

(IR-DRGs)

l f d

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International Refined DRGs(IR-DRGs)

The objectives of the IR-DRGs:

Develop a DRG system that can be modified tocountry 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 clinicalmanagement of patient outcomes

i l fi d G

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International Refined DRGs(IR-DRGs)

Objectives Develop a classification system that defines

all age groups

Develop a classification system that iscomparable across different coding systems

Patients will be assigned to the same DRGregardless of the coding systemHistorical data can be compared

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International Refined DRGs(IR-DRGs)- Version 2

Services CoveredHospital In-patientDay Care SurgerySpecialist ClinicEmergency Room

General Out-patientRehabilitationChemotheraphy and RadiotherapyMental Health Services and Procedures

Cover Inpatient, outpatient and Day CareTotal DRGs: 1168

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IR-DRG Version 2.06 Digit System

1 2 3 4 5 6

MDC SEVERITYBASEDRG

DRG TYPE

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Training & Education

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Speciality Workshops

Coding Certificate

Foundation Training

Refresher Workshops

Audit/Trainer

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Foundation Modules

CONTENT Medical

terminology Anatomy &

Physiology ICD-10 ICD-9 CM

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Foundation Modules

3 modules

14 days

Assessments

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Refresher Workshop

Anatomy &Physiology

ICD-10ICD-9 CMCase studies

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Refresher Workshop

3 days

Cover Essential

pointers

Case studies

When to attend

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Specialty Workshops from

Obstetrics

Cardio-

Vascular

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Specialty Workshops

Cover both ICD-10 &ICD-9 CMClinical input

Case studies

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Additional Workshops

AuditBeginners &

Advanced

Train thetrainer

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Who else requires

training/awarenessCliniciansFinanceDepartmentsInformationDepartments

ClinicalGovernanceDOHAnalysts

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Trainers

Who makes thebest trainer

Individuals with strong subject matter

Individuals versed in adult learning

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icd x medan 2008

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