Principles to Guide Maintenance of Classifications

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Principles to Guide Maintenance of
Classifications

• Kathy Giannangelo, RHIA, CCSAmerican Health
  Information Management Association

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Agenda

• Review maintenance processes
• Describe problems associated with the processes
• Present examples of the data that results from
  not having a set of principles
• Identify best practice principles

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Maintenance Processes

• US ICD-9-CM
• Coordination and Maintenance Committee
• Federal committee
• Suggestions from both the public and private
  sectors
• Public meetings
• Administrator of the Centers for Medicare and
  Medicaid Services and the Director of the
  National Center for Health Statistics

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Maintenance Processes

• WHO ICD-10
• WHO Collaborating Centres for the FIC and
  Mortality Reference Group
• Update and Revision Committee
• Policies and procedures
• Criteria for updates, e.g., minor and major
  change
• Update cycle and mechanism
• Procedures, e.g., submission guidelines

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Maintenance Processes

• WHO ICD-10
• Heads of Collaborating Centres
• WHO Secretariat
• Maintenance tool under development by the German
  Institute of Medical Documentation and
  Information (DIMDI)

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Maintenance Processes

• CA ICD-10-CA
• ICD-10 updates
• ICD-10-CA updates
• On-line submission process
• Classification Advisory Committee
• Change Request database
• 3 year maintenance cycle in congruence with WHO
  cycle of major updates

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Maintenance Processes

• AU ICD-10-AM
• ICD-10 updates
• ICD-10-AM updates
• Suggestions from a variety of sources
• Various committee, e.g., Coding Standards
  Advisory Committee
• Task database
• ICD-10-AM Chronicle
• Biennial cycle, Fifth Edition in July 2006

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Problems with the Process

• Duplicative work
• No standard for
• Guidelines for submissions
• Identifying changes
• Tracking changes
• Time it takes to approve and implement changes
• Difficult to compare morbidity data among
  countries

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Example
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Example
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I25.1, Atherosclerotic Heart Disease

• I25.10
• ICD-10-AM Atherosclerotic heart disease of
  unspecified vessel
• ICD-10-CA Atherosclerotic heart disease of
  native coronary artery
• ICD-10-CM Atherosclerotic heart disease of
  native coronary artery without angina pectoris

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I25.1, Atherosclerotic Heart Disease

• I25.11
• ICD-10-AM Atherosclerotic heart disease of
  native coronary artery
• ICD-10-CA Atherosclerotic heart disease of
  autologous vein bypass graft
• ICD-10-CM Atherosclerotic heart disease of
  native coronary artery with angina pectoris

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Example
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Best Practice Selection Factors

• Customer feedback
• Cost
• Available resources
• Timing or priorities
• Organizational culture
• External forces such as laws and regulations

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Rationale for Best Practice Principles

• Greater likelihood of international harmonization
  of morbidity data
• Better healthcare data

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Principles to Guide Maintenance

• The committee responsible for system maintenance
  should be comprised of representatives of all
  major stakeholder groups, including the
  government, providers, and private payers.

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Principles to Guide Maintenance

• The maintenance process should be open, with
  public meetings (broadcast live over the
  Internet) and opportunities for public input both
  at and outside of the meetings.

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Principles to Guide Maintenance

• Due to the rapid advances in medicine and
  technology and the immediate need for codes to
  describe these advances, the maintenance process
  should be more streamlined, with consideration
  given to the feasibility of more frequent system
  updates.

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Principles to Guide Maintenance

• The lag time between proposal of a new code and
  its implementation should be minimized.

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Principles to Guide Maintenance

• There should be an established process for
  developing rules and guidelines for the correct
  application of the coding system. The process
  should be open and permit broad input from all
  stakeholders prior to finalization of a
  significantly revised or changed guideline. The
  coding system rules and guidelines (and
  consequent payment system changes) should be
  updated on the same schedule as the code set and
  made part of the official version.

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Principles to Guide Maintenance

• All requisite materialscode sets, guidelines,
  and other directivesshould be in formats
  available from government or private entities. 
  This would ensure that all stakeholders know
  where to go for unfettered access to the
  official, most up-to-date versions and
  interpretive materials.

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Expected Results

• More efficient and effective maintenance
• Take advantage of the available IT applications
  and tools
• User needs are met
• Greater consistency, stability, and integrity
• International modifications
• Coordinated maintenance process
• Clinical terminologies
• IMPROVED DATA

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kathy.giannangelo_at_ahima.org