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 Contains –Over 100 indicators: Fatal, Warning, Relative –Denominator / Numerator –Denominator count = records looked at –Numerator count = records with problem

Indicator Examples Records with rehabilitation care type but PDx code not admission for rehab Obstetric perineal laceration 1 st/ 2 nd 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

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

Data Analysed AIHW DataICD-10-AM Edition 2000 Jan-JunICD-10-AM 1 st Edition 2000 Jul-DecICD-10-AM 2 nd Edition Fin. Year ICD-10-AM 2 nd Edition Fin. Year ICD-10-AM 3 rd Edition

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

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

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

Comparison of fatal indicator error rates between jurisdictions

Fatal Indicators with high rates Indicator1st Ed2nd Ed3rd Ed Jan-Jun /022002/03 Secondary neoplasm site code without primary site code Alzheimer's disease code without dementia code Newborn affected by C/S w/out code indicating effect Type of spinal cord lesion w/out functional level of spinal cord lesion

Comparison of warning indicator error rates between jurisdictions

Warning Indicators with high rates Indicator1st Ed2nd Ed3rd Ed Jan-Jun /022002/03 Cataract code as principal diagnosis before glaucoma code Insertion of pacemaker code without insertion of electrode code Diabetes mellitus, non insulin-dependant, age <30 years Respiratory distress of newborn unspecified

Relationship between Fatal and Warning Indicators

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

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

Outcomes From PICQ Analysis NCCH Coder education (including in Coding Matters) Development of ICD-10-AM 4 th 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

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 4 th edition codes) –97 New indicators for 4 th edition –223 Total indicators for 4 th edition