Overview of Supplementary Codes for Chronic Conditions
Since its implementation in the First
Edition of the Australian Coding Standards (ACS) in July 1998, ACS 0002 Additional diagnoses
has been under continued scrutiny.
Over the years it has undergone numerous
modifications, with later iterations largely restricting the assignment
of additional diagnoses codes to only when a condition affects
patient management in the particular
episode of care. The challenge has been, and remains to be, how to
determine which conditions should be considered as "affecting patient
management".
It has also been noted that the criteria
in ACS 0002 appears to have led to an overly rigorous application. This
has resulted in the coding of what may be considered minor
complaints and symptoms and at the same
time, under coding of chronic conditions that don't obviously meet the
criteria for assignment outlined in ACS 0002. Even though these
chronic conditions by their nature are
important for patient management in terms of "treatment required,
investigations needed and resources used" and are vital in collecting
data to satisfy the other use cases of
the classification, they are not always coded.
The use cases of the clinical classification are many. The Guidance in the use of ICD-10-AM (ICD-10-AM, Tabular List)
highlights these use cases beyond its original
purpose to provide access to information
contained in medical records for research, education and
administration, and includes:
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quality assurance activities
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epidemiological studies
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health care planning and evaluation
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payment of health services
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Significantly, the codes are used to
assign episodes of care into Diagnosis Related Groups (DRGs), which are
designed to categorise episodes of patient care into clinically
coherent groups with similar resource
utilisation for the purposes of casemix based funding and analysis.
Ongoing review and development of the
clinical classification, including the conventions and standards, is
essential to ensure that the classification is able to meet the
diverse requirements of its many
applications. The interpretation and application of ACS 0002, in
conjunction with ACS 0001 Principal diagnosis, is fundamental in
achieving consistent, complete and meaningful coded clinical data.
To address these issues an evidence-based, phased review of ACS 0002 Additional diagnoses
is being commenced in Ninth Edition with the long term goal of ensuring
that
"clinically important" conditions are
included in the coded data, so that the data collection is appropriate
for both current and future use cases, including the management of
chronic conditions.
This goal is difficult from several perspectives:
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it is not always clear in
the documentation that a condition should be coded as an additional
diagnosis, particularly in relation to many underlying chronic
conditions.
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defining the conditions that are clinically important is a challenging task.
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an inappropriate outcome
would be assigning codes for every condition documented in a clinical
record, resulting in meaningless data.
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The review is being conducted by:
| 1. |
The creation of 29 codes in the range U78-U88 Supplementary codes for chronic conditions representing a selection of clinically important conditions which will reside in
Chapter 22 Codes for special purposes. These codes should always be assigned where it is documented that a condition is present during an episode of admitted
patient care, but it has not met the criteria for coding (as instructed in ACS 0002 Additional diagnoses
and other general and specialty coding standards,
conventions and rules). The
list of "clinically important" conditions has been minimised so as to be
comprehensive enough to capture meaningful data for analysis
without causing undue
clinical coder burden.
These "U" codes are excluded
from the AR-DRG grouping process and will not impact DRGs or Activity
Based Funding.
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| 2. |
Creation of ACS 0003 Supplementary codes for chronic conditions to provide classification advice for the assignment of the supplementary codes for chronic conditions.
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| 3. |
Revision of ACS 0002 Additional diagnoses to include reference to ACS 0003.
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In order for sufficient data to be
collected, these "U" codes will be assigned for an initial period of two
development cycles (i.e. four years). The resulting data collection
will be
analysed, both to determine the
frequency of additional coding and to measure the impact on resource
consumption (if any). This comprises the initial phase of the review.
The results will be used to inform the
second phase of the review to determine what changes may be required to
ACS 0002 Additional diagnoses.
Impact on Clinical Coding
Minimising the impact on clinical coders
was considered in the development of the supplementary codes for
chronic conditions. Clinical coders already consider all patient
conditions for
qualification of ACS 0002 criteria and
other general and specialty coding standards, conventions and rules.
With the introduction of ACS 0003, nominated conditions which do not
otherwise
qualify for assignment will instead be
assigned a "U" code without the need for further processing.
The impact on clinical coders will be minimised due to:
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the supplementary codes for
chronic conditions being less granular than the other chapter codes.
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clinical coder familiarity
with the supplementary codes with a PDF quick reference guide being
provided (see links below).
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Click here for a downloadable PDF of ACS 0003 Supplementary codes for chronic conditions.
Click here for a downloadable PDF of ICD-10-AM code range U78-U88 Supplementary Codes for Chronic Conditions.
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