CLINICAL CODING FOR BM & PBSC TRANSPLANT PROCEDURES Dr Kim Orchard – Transplant Director Carol Hurlock – Data Manager Wessex Blood and Marrow Transplantation Service

Introduction Discrepancy between WBMTU activity as returned to EBMT and local Patient Administration System (PAS) – ‘coding errors’ Not just an internal issue of coding – Central South Coast Specialist Services Commissioners report on our BMTs - accessing PAS only

Introduction yearCSCSSCActual autoalloautoallo 2003/4 2004/5 2005/ What they thought we did vs what we actually did

Introduction Concerns raised with the BSBMT How widespread was this problem? - survey of coding practice in transplant centres

Aim To determine whether transplant procedure coding is consistent across the UK To establish the codes currently used by UK transplant centres To raise awareness of the importance of clinical coding for transplant procedures To present the findings to the BSBMT Executive Committee

Plan Design two questionnaires –One to be completed by the transplant clinician –One to be completed by the clinical coding department within the transplant centre Questionnaires sent and responses collected by Keiren Towlson on behalf of the BSBMT

Process Both questionnaires sent 27 th April 2006 to 56 teams in 53 UK transplant centres Total of 18 clinical coding department questionnaire responses received Analyse responses received by 20 th Nov 2006 (following 1 reminder) Total of 16 clinician questionnaire responses received

Results: Clinician Questionnaire QuestionTotal response YesNoComment Do you or your colleagues have contact with your hospital clinical coding department with regard to the coding of BM and PBSC procedures? 16214Contact was made monthly for 1 centre and every 6 to 12 months for the other centre Do you or your colleagues experience any difficulty in obtaining transplant procedure data from your hospital patient administration system? centres had not tried to extract any data from PAS Is your EBMT transplant activity data validated each year against the data recorded within the hospital patient administration system? centres were not aware if their data was validated

Results: Coding Dept. Questionnaire QuestionTotal responses YesNoComments Do you have a dedicated person to code BM and PBSC transplant procedures? Does the clinical coder have access to the hospital case notes to undertake coding of transplant procedures? 16142Case notes were accessed for coding always in 11 centres and sometimes in 3 centres Does the clinical coder meet with clinical staff from the transplant team within your hospital? 1697Contact was made regularly in 2 centres and occasionally in 7 centres

Results: Coding Dept. Questionnaire QuestionTotal responses YesNoComment Has there been any direction sought from your department as to the OPCS codes to use for transplant procedures? 18117Direction was sought from coding personnel in 4 centres and from clinicians in 6 centres (blank for the other centre) Have the OPCS codes you currently use for transplant procedures been agreed / signed off by the consultant(s) in transplantation within your hospital? Are complications coded that occur during the patient’s inpatient episode for transplant? 18162Complications are coded routinely in 13 centres and occasionally in 1 centre (blank for the other 2 centres)

Results: OPCS v4.3 Codes Used 3 centres use only 1 code which did not reflect a harvest procedure BM Harvest 11 of 14 use Y667 = Harvest of BM - 9 centres use 2 codes (incl. Y667) to reflect the harvest procedure undertaken - 5 centres use the same 2 codes - 1 centre use 3 codes adding “1 st stage of staged operation” - 1 centre use only Y667

Results: BM Harvest X327 = Leucopheresis W358 = Introduction bone substance puncture bone therapeutic ( other specified) W341 = Graft of BM Auto of BM nec

Results: PBSC Harvest N.B. There is no specific PBSC harvest code 14 of 16 use harvest codes - 12 centres use “Harvest of other tissue” - 2 centres use “BM harvest” 1 centre use “Leucopheresis” only (same centre as for BM harvest) 1 centre use “Blood donation”

Results: PBSC Harvest - Y361 = Blood donation - Y698 = Harvest of other tissue - Y703 = First stage of staged operation 8 of 14 centres use the same 3 codes to reflect PBSC harvest procedure

Results: Donor Harvest 1 centre use W341 = Graft of BM - Auto of BM for BM and PBSC (same centre as before) 9 of 11 centres use donation and / or harvest codes for BM and PBSC harvest procedures 1 centre uses X327 = Leucopheresis for BM and PBSC (same centre as before)

Results: Autologous BM Transplant 2 centres added Y711 = 2 nd stage of staged operations 13 of 14 centres use W341 = Graft of BM Auto of BM nec to reflect autologous BM transplant procedure 1 centre use X338 = Other blood transfusion other specified

Results: Autologous PBSC Transplant N.B. There is no specific autologous PBSC transplant code 10 of 16 use X338 = Other blood transfusion other spec and Y711 – 2 nd stage of staged operations 1 centre use code X338 only 5 centres use W341 = Graft of BM Auto BM nec

Results: Allogeneic BM Transplant 10 of 11 centres use W34. codes specific to BM allograft transplant procedures 1 centre use X468 = Donation of other tissue

Results: Allogeneic PBSC Transplant 5 of 11 centres use X338 = Other blood transfusion 5 centres use W34. codes specific to BM allograft transplant procedures 1 centre use X468 as for BM N.B. There is no specific code for PBSC Allogeneic transplant

Summary - 1 Clinician and clinical coding department response about their contact with each other did not correlate Less than half of the centres who responded validate their EBMT activity data against their PAS Coding transplant complications in 16 of 18 centres. However, access to case notes occurred in only 14 centres!

Conclusions - 3 Summary centres reported codes for harvest and donor harvest that do not reflect these procedures 1 centre reported coding BM and PBSC autologous transplant as a blood transfusion 1 centre reported coding BM and PBSC allogeneic transplant as donation of other tissue

Conclusions - 4 Conclusions BM autologous and allogeneic transplant coding is the most accurate. - This is probably due to the fact that there are specific OPCS codes available Accuracy of clinical coding for bone marrow and peripheral stem cell transplant procedures is vital for both costing and quality purposes especially in a payment by results system There is a need for specific national guidance and new OPCS codes to accurately reflect PBSC transplant procedures

Recommendations BSBMT to request all UK transplant centres validate their transplant activity prior to submission to the EBMT Registry against PAS Allocating specific personnel in coding would improve the consistency of coding for transplant procedures

New Release – OPCS v4.4 X33.4 – Autologous peripheral blood stem cell transplant X33.5 – Syngeneic peripheral blood stem cell transplant X33.6 – Allogeneic peripheral blood stem cell transplant W99 – Graft of cord blood stem cells to BM W99.1 – Allograft of cord blood stem cells to BM