International Classification of Diseases, Tenth Revision Implementation: Is the Workforce Ready?

After many delays, the United States finally implemented the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedural Coding System on October 1, 2015, bringing the United States into line with other industrialized nations, most of which had been using the International Classification of Diseases, Tenth Revision for many years. We outline the benefits and challenges to the preparatory activities of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedural Coding System implementation for the US health care industry. To ease the transition, the Centers for Medicare & Medicaid Services allowed health care facilities to submit test claims prior to the implementation date and delivered feedback on the acceptability of those claims. Early results indicated a relatively smooth transition, although some questions regarding the available data remain. Additional data, especially data concerning outcomes, are required.

Assessment of the coding accuracy of warfarin-related bleeding events.

INTRODUCTION: Using International Classification of Diseases, 9th edition (ICD-9) diagnosis codes to identify potential warfarin-related bleeding events from administrative datasets is highly efficient but may be prone to identifying non-events. The objective of this study was to evaluate the ability of bleeding-related ICD-9 codes to identify true bleeding events in patients who were receiving warfarin therapy at the time of hospitalization. METHODS: This was a cross-sectional study conducted in an integrated healthcare delivery system. Anticoagulated patients aged ≥18years and hospitalized between January 1, 2014 and March 31, 2014 were identified using administrative data queries. All hospitalizations were manually chart reviewed by a trained abstractor blinded to hospitalization diagnoses to assess for true bleeding events. Identification of the presence or lack of bleeding-related ICD-9 diagnosis code(s) for each hospitalization was then performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each ICD-9 code present. RESULTS: There were 486 hospitalizations in 468 anticoagulated patients with 57 true bleeding events identified. Patients had a mean age of 73.4years and 50% were female. For codes in the principal position, sensitivity, specificity, PPV, and NPV were 7.0%, 99.8%, 80.0%, and 89.0%, respectively. For codes in any position, sensitivity, specificity, PPV, and NPV were 94.7%, 90.9%, 58.1%, and 99.2%, respectively. For major bleeding, sensitivity, specificity, PPV, and NPV were 100%, 83.1%, 14.0%, and 100%, respectively. CONCLUSIONS: While the absence of a bleeding ICD-9 code reliably ruled-out hospitalization for warfarin-related bleeding, bleeding ICD-9 codes in the principal position were rarely used and undesirable false positive rates were identified when ICD-9 codes when recorded in any position and for major bleeding. Manual chart review is recommended to validate bleeding events from administrative data.

Mental and behavioural disorders in the ICD-11: concepts, methodologies, and current status. / Zaburzenia psychiczne i behawioralne w ICD-11: koncepcje, metodologie oraz obecny status.

This review provides an overview of the concepts, methods and current status of the development of the Eleventh Revision of the Mental and Behavioural Disorders chapter of the International Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization (WHO). Given the global use of the current version (ICD-10) for a wide range of applications in clinical practice and health statistics, a major aim of the development process for ICD-11 has been to increase the utility of the classification system. Expert working groups with responsibility for specific disorder groupings first suggested a set of revised diagnostic guidelines. Then surveys were performed to obtain suggestions for revisions from practicing health professionals. A completely revised structure for the classification of mental and behavioural disorders was developed and major revisions were suggested, for example, for schizophrenia and other primary psychotic disorders, substance use disorders, affective disorders and personality disorders. A new category of "gaming disorder" has been proposed and conditions related to sexual health and gender identity will be classified separately from mental disorders. An ICD-11 beta draft is freely available on the internet and public comments are invited. Field studies of the revised diagnostic guidelines are in process to obtain additional information about necessary improvements. A tabulated crosswalk from previous ICD-10 to then ICD-11 criteria will be necessary to ascertain the continuity of diagnoses for epidemiological and other statistical purposes. The final version of ICD-11 is currently scheduled for release by the World Health Assembly in 2018.

Automated Classification of Semi-Structured Pathology Reports into ICD-O Using SVM in Portuguese.

Pathology reports are a main source of information regarding cancer diagnosis and are commonly written following semi-structured templates that include tumour localisation and behaviour. In this work, we evaluated the efficiency of support vector machines (SVMs) to classify pathology reports written in Portuguese into the International Classification of Diseases for Oncology (ICD-O), a biaxial classification of cancer topography and morphology. A partnership program with the Brazilian hospital A.C. Camargo Cancer Center provided anonymised pathology reports and structured data from 94,980 patients used for training and validation. We employed SVMs with tf-idf weighting scheme in a bag-of-words approach and report F1 score of 0.82 for 18 sites and 0.73 for 49 morphology classes. With the largest dataset ever used in such a task, our work provides reliable estimates for the classification of pathology reports in Portuguese and agrees with a few similar studies published in the same kind of data in other languages.

[Improving the visibility of rare diseases in health care systems by specific routine coding]. / Verbesserung der Sichtbarkeit seltener Erkrankungen in Gesundheitssystemen durch spezifische Routinekodierung.

The evaluation of healthcare providers' routine data is an important basis for the analysis, planning and evaluation of measures in public health. The representation of rare diseases in the classifications that are used to record health data is not adequate. Coding rare diseases in a specific way is a challenge all around the world. There is still no general international solution for the routine coding of rare diseases.The double coding of rare diseases with ICD-10 Codes and Orphacodes is a short-term and low-cost alternative solution. Furthermore, this double coding enables international comparability. The specific encoding of rare diseases through this double coding can improve their capturing for statistical analysis and thus their visibility in healthcare systems. Nevertheless, the provision of a new classification is not enough to gather valid data. Some measures have already been adopted in Germany (and at the European level) in order to support the implementation of this double coding. Subsequently it would be possible to adopt more specific public health measures, based on better data, in order to provide better care to the more than four million people in Germany affected by rare diseases.

El trastorno de Tourette a lo largo de la historia / Tourette’s disorder in history

El término trastorno de Tourette emerge en el campo de la psiquiatría con la aparición de la tercera edición del Manual Diagnóstico y Estadístico de Trastornos Mentales (DSM-III) en el año 1980. Sin embargo, el hecho de que se consensuaran sus criterios diagnósticos por el grupo de expertos responsable de la elaboración de dicha versión del DSM no implica que previamente no existieran múltiples referencias a su sintomatología. El objetivo de este trabajo es recoger aportaciones de la historia de la neurología y de la psiquiatría que permitan comprender cómo se ha ido configurando el concepto operativo de trastorno de Tourette tal como es aceptado en la actualidad por una gran parte de la comunidad científica. En la última década, merced a los estudios de asociación de todo el genoma, se han producido importantes avances en la identificación de variantes comunes y variantes raras implicadas en la etiología del trastorno de Tourette. La conclusión más relevante que se desprende de esta revisión es poner al descubierto la crisis del modelo categórico kraepeliniano del trastorno (AU)

The term Tourette’s disorder emerged in the field of psychiatry with the appearance of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. However, the fact that some diagnostic criteria were agreed by the expert group responsible for the development of this version of the DSM diagnostic criteria does not mean that multiple references to the symptoms of the disorder did not previously exist. The aim of this review is to collect contributions from the history of neurology and psychiatry which allow us to understand how the operating concept of Tourette’s disorder has been progressively shaped as it is currently accepted by the scientific community. In the last decade, thanks to studies of genome association, major advances have arisen in identifying common variants and rare variants involved in the etiology of Tourette’s disorder. The most important conclusion of this review is the disclosure of the crisis of the Kraepelinian categorical model of the disorder (AU)

Evaluating Open-Source Full-Text Search Engines for Matching ICD-10 Codes.

This research presents the results of evaluating multiple free, open-source engines on matching ICD-10 diagnostic codes via full-text searches. The study investigates what it takes to get an accurate match when searching for a specific diagnostic code. For each code the evaluation starts by extracting the words that make up its text and continues with building full-text search queries from the combinations of these words. The queries are then run against all the ICD-10 codes until a match indicates the code in question as a match with the highest relative score. This method identifies the minimum number of words that must be provided in order for the search engines choose the desired entry. The engines analyzed include a popular Java-based full-text search engine, a lightweight engine written in JavaScript which can even execute on the user's browser, and two popular open-source relational database management systems.

Getting Ready for ICD-10 and Meaningful Use Stage 2.

For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.9 times more codes than the International Classification of Diseases, Ninth Revision. ICD-10-CM allows for more specific descriptors of a procedure and is broken down by category, etiology, anatomic site, severity, and extension. ICD-10-CM is scheduled to be implemented by Medicare and commercial payers on October 1, 2015. In addition to ICD-10 implementation, physicians have to meet the requirements of the Meaningful Use Electronic Health Record Incentive Program. The Meaningful Use program is designed to promote the use of certified electronic health technology by providing eligible professionals with incentive payments if they meet the defined core and menu objectives of each stage of the program. All core measures must be met; however, providers can choose to meet a preset number of menu measures. Meaningful Use Stage 1 required eligible professionals to meet core and menu objectives that focused on data capture and sharing. Meaningful Use Stage 2 requires eligible professionals to meet core and menu objects that focus on advanced clinical processes for a full year in 2015. Stage 3 has been delayed until 2017, and core and menu measures that will focus on improving outcomes have not yet been defined. It is important for orthopaedic surgeons to understand the history of and techniques for the use of ICD-10-CM in clinical practice. Orthopaedic surgeons also should understand the requirements for Meaningful Use Stages 1 and 2, including the core objectives that must be met to achieve satisfactory attestation.

Optimization and simplification of the Allergic and Hypersensitivity conditions classification for the ICD-11.

BACKGROUND: Since 2013, an international collaboration of Allergy Academies, including first the World Allergy Organization (WAO), the American Academy of Allergy Asthma and Immunology (AAAAI), and the European Academy of Allergy and Clinical Immunology (EAACI), and then the American College of Allergy, Asthma and Immunology (ACAAI), the Latin American Society of Allergy, Asthma and Immunology (SLAAI), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), has spent tremendous efforts to have a better and updated classification of allergic and hypersensitivity conditions in the forthcoming International Classification of Diseases (ICD)-11 version by providing evidences and promoting actions for the need for changes. The latest action was the implementation of a classification proposal of hypersensitivity/allergic diseases built by crowdsourcing the Allergy Academy leaderships. METHODS: Following bilateral discussions with the representatives of the ICD-11 revision, a face-to-face meeting was held at the United Nations Office in Geneva and a simplification process of the hypersensitivity/allergic disorders classification was carried out to better fit the ICD structure. RESULTS: We are here presenting the end result of what we consider to be a model of good collaboration between the World Health Organization and a specialty. CONCLUSION: We strongly believe that the outcomes of all past and future actions will impact positively the recognition of the allergy specialty as well as the quality improvement of healthcare system for allergic and hypersensitivity conditions worldwide.

La experiencia de implantación del nuevo Registro de Atención Sanitaria Especializada y la transición a la CIE10 en los hospitales españoles. Proceso y resultados esperados / No disponible

No disponible

New Morbidity and Comorbidity Scores based on the Structure of the ICD-10.

Measures of morbidity and comorbidity are frequently used for the control of confounding, particularly in health services research. Several proposals for those measures are defined with ICD-coded diagnoses available in hospital routine data. However, a measure that makes use of the ICD structure is missing. Objective of this work was to elaborate the power of the ICD structure for defining morbidity and comorbidity measures. Routine data from three German hospitals with inpatients discharged 2008 were used for model development; routine data from 36 German hospitals with inpatients admitted and discharged 2010 were used for model evaluation. Two different risk models were developed, one based on ICD-10 chapters, the other based on ICD-10 groups. The models were transformed into sum scores using whole-number weights. Models and scores were compared with the Charlson Index and the Elixhauser Comorbidities using the receiver operating characteristic. Dependent variable was hospital death. Logistic regression was used to derive the new models. Charlson Index and Elixhauser Comorbidities were mapped to the German ICD-10. According to the receiver operating characteristic, the quality of the measures based on the structure of the ICD-10 was superior compared with the Charlson Index and the Elixhauser Comorbidities. The best result was achieved with the measure based on ICD-10-groups with an area under curve of 0.910 (95% confidence interval = 0.907-0.913). The sum scores showed a comparable performance. The developed new measures may be used to control for confounding.

[For discussion: Quality assurance in medical care - is PKMS the right way to go?]. / Zur Diskussion: Qualitätssicherung in der Pflege - mit PKMS auf dem richtigen Weg?

Hospitals are legally obliged to take part in external comparative quality assurance programs. Quality indicators for pressure ulcer prevention are among the most widely used for geriatric clinical institutions. To enable more precise risk adjustment established risk factors are employed in conjunction with the OPS 9-200. Using a PKMS case to produce an OPS 9-200 is far too heterogeneous, sketchy and vague to create an accurate and satisfactory pressure ulcer risk assessment for patients with varied and individual case factors. Therefore we propose to include risk factors which, according to experts, are clearly and specifically related to pressure ulcers (e.g. immobility and incontinence) and matched by unique ICD codes.

Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study.

The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.

La codificación como instrumento en la gestión clínica de las unidades del dolor / The codification as tool in the clinic management of pain units

Introducción: los principales instrumentos de información para la gestión clínica se basan en la recogida sistemática de datos clínicos, que se materializa en el CMBD, y en la utilización de sistemas de clasificación de pacientes, siendo los AP-GRD los adoptados en nuestro país por la administración sanitaria. Los datos necesarios para realizar la agrupación en GRD están contenidos en el CMBD y entre ellos están: diagnóstico principal, intervenciones o procedimientos y diagnósticos secundarios, que deben estar codificados con la CIE-9-MC. El sistema GRD es un instrumento de gestión, que permite una contabilidad analítica, a través de los pesos relativos de cada GRD. Objetivos: mostrar la codificación de los diagnósticos que se realizan en una Unidad Multidisciplinar de Dolor Crónico mediante la CIE-9-MC, único sistema reconocido a nivel institucional, y evidenciar la importancia que tiene la codificación correcta de los diagnósticos de dolor para obtener los GRD que describan más adecuadamente el grado de complejidad de los procesos tratados, con su correspondiente 'coste por proceso'. Material y métodos: se han revisado las historias clínicas para obtener la información necesaria para realizar la codificación. A cada diagnóstico se le asigna un código principal y si es preciso uno o varios códigos secundarios. Se debe asignar un código para el procedimiento realizado. Una vez realizada la codificación, junto con los datos necesarios de cada paciente, se obtienen los diferentes GRD, con sus pesos correspondientes. Resultados: se han codificado diagnósticos con la CIE-9-MC desde el año 2002 al 2012, realizando una base de datos con la codificación de los diagnósticos más frecuentes en una Unidad de Dolor. Se ha obtenido cada año información sobre la agrupación de patologías mediante GRD, y su peso correspondiente. De 2002 a 2009 el GRD más frecuente fue el 243, 'Patología médica de columna vertebral' en el 57% de los casos. A partir del año 2010 se introdujo la nueva codificación que incluye el código 338 y como consecuencia cambiaron los GRD. La categoría 338, 'Dolor no clasificado bajo otros conceptos', se enmarca dentro del capítulo de Enfermedades del Sistema Nervioso y Órganos de los Sentidos. Los GRD más frecuentes han sido: 035, 'Otros trastornos del sistema nervioso, sin CC' en el 42,28% de los casos; 243 'Patología médica de columna vertebral' en el 18% y 019 'Trastornos de nervios craneales y periféricos sin CC' en el 15,5%. Se describen las características de estos GRD y los diagnósticos de dolor que se han incluido en cada uno de ellos. Conclusiones: el uso de la codificación de diagnósticos y procedimientos con la CIE-9-MC supone un esfuerzo por unificar el lenguaje que se utiliza en la práctica clínica. Es preciso que la codificación se realice correcta y consistentemente para obtener resultados que reflejen la actividad real que se realiza en un servicio y lo que cuesta. Para que realmente la codificación influya en la gestión clínica por procesos, es fundamental que los responsables de las unidades conozcan estas herramientas. A medio plazo, se instaurará en la actividad clínica en España el uso de la CIE-10-MC (AU)

Introduction: The main tools of information for clinical management are based on the systematic collection of clinical data, which is embodied in the MDS (Minimum Basic Data Set), and the use of patient classification systems, being the AP-DRGs those adopted in our country for the health administration. The data needed to perform the grouping DRGs are contained in the MDS and among them are: The main diagnosis, interventions or other procedures performed and secondary diagnoses, which should be coded with ICD-9-CM. The DRG system is a management tool that allows an analytical accounting system, through the relative weights of each DRG. Objectives: To show the codification of diagnoses that are carried out in a Multidisciplinary Unit of Chronic Pain by ICD-9- CM, unique system officially recognized by our health services, and demonstrate the importance that correct coding of diagnoses of pain has to obtain the DRGs that best describe the degree of complexity of the processes that are treated, with the corresponding 'cost per case'. Material and methods: We reviewed the medical records to obtain the information necessary to perform the encoding. For each diagnoses a master code (main diagnoses) is assigned and if necessary one or more secondary codes are added. It is assigned a code for the procedure performed. Once the codification is obtain, along with the necessary data for each patient, the various DRGs are obtained, with their corresponding weights. Results: Diagnoses were coded with ICD-9-CM from 2002 until 2012, performing a database with encoding of the most common diagnoses in a chronic pain unit. It has been obtained each year information about grouping of pathologies by DRG, and its weights. From 2002 to 2009 the most common DRG was the 243, 'Medical pathology of spine', that account for 57% of cases. Beginning in 2010, the new codification was introduced, including the code 338 and as a consequence the DRGs changed. The category 338, 'Pain not classified under other concepts', is part of the chapter of Diseases of the Nervous System and Senses Organs. The most frequent DRGs were: 035 'Other disorders of nervous system without CC', 42.28% of cases; 243 'Medical pathology spine' 18% and 019 'Disorders of cranial and peripheral nerves without CC' 15.5%. The characteristics of these DRGs are described together the diagnoses of pain that are included in each of them. Conclusions: The use of coding diagnoses and procedures with ICD-9-CM is an effort to unify the language used in clinical practice. It is necessary that the coding is done correctly and consistently to get results that reflect real activity that takes place in a service and what it costs. In order for the codification to become relevant in the clinical management by processes, it is essential that the unit managers must be familiar with these tools. In the medium term, the used of ICD-10-CM will be established in clinical practice in Spain (AU)