1. 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

2. 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

3. 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

4. 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

5. Data Analysed AIHW DataICD-10-AM Edition 2000 Jan-JunICD-10-AM 1 st Edition 2000 Jul-DecICD-10-AM 2 nd Edition 2001-02 Fin. Year ICD-10-AM 2 nd Edition 2002-03 Fin. Year ICD-10-AM 3 rd Edition

6. 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

7. 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

8. Results: Changes over time using ICD-10-AM 2 nd Edition Jul-Dec 2000 compared to 2001-02 4 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 2001-02 4 of 5 States improve their overall Warning indicator rate –Less marked change than for Fatal indicators

9. Comparison of fatal indicator error rates between jurisdictions

10. Fatal Indicators with high rates Indicator1st Ed2nd Ed3rd Ed Jan-Jun 20002001/022002/03 Secondary neoplasm site code without primary site code 2.302.632.70 Alzheimer's disease code without dementia code 8.5611.009.68 Newborn affected by C/S w/out code indicating effect 80.2263.8942.32 Type of spinal cord lesion w/out functional level of spinal cord lesion 54.4927.2126.41

11. Comparison of warning indicator error rates between jurisdictions

12. Warning Indicators with high rates Indicator1st Ed2nd Ed3rd Ed Jan-Jun 20002001/022002/03 Cataract code as principal diagnosis before glaucoma code 28.4028.5626.50 Insertion of pacemaker code without insertion of electrode code 98.7917.1918.88 Diabetes mellitus, non insulin-dependant, age <30 years 19.2219.5023.25 Respiratory distress of newborn unspecified 21.2018.6715.43

13. Relationship between Fatal and Warning Indicators

14. 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

15. 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

16. 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

17. 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