On a Lighter Note by 2CxzIx

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									ICD Coding Newsletter
        August 1999




 Hospital Distribution List

    Health Information Manager/s (HIMS)
    Clinical Coders
    Information Technology (IT)
    Interested Others
      ……………………
      ……………………
      ……………………
The ICD Coding Newsletter supports the clinical coding function performed
in Victoria by Health Information Managers and Clinical Coders, by
providing relevant information for these professionals and their associates.


The newsletter, prepared by the Victorian ICD Coding Committee in conjunction
with the Department of Human Services, seeks to:
   ensure the standardisation of coding practice across the state
   provide a forum for resolution of coding queries
   address topical coding education issues, and
   inform on national and state coding issues from the Victorian perspective.


The scope of the newsletter includes answers to selected coding queries, coding
feature articles, and feedback on the quality of coded data (as reported to the
Victorian Admitted Episodes Dataset).



Should you have any queries or comments regarding the ICD Coding Newsletter,
contact:
Wendy Dickins, Sara Harrison or Shannon Watts.


HDSS Help Desk:
Telephone        9616 8141
Fax              9616 7629
Email            PRS2.Help-Desk@dhs.vic.gov.au
Website          www.dhs.vic.gov.au/ahs/hdss




The following proformas are provided for your use:


  Victorian ICD Coding Committee Query Form
      (Refer to page 19 of the May 1999 edition of this newsletter for guidelines on query
      submission, including alternative means of lodging a query.)
  Changes to Mailing Details.
Editors’ Note
In July 1999, the first issue of the Health Data Standards and Systems Bulletin was
distributed to Victorian hospitals and industry bodies. Two further issues have been
released since then.


This Bulletin is produced on an ad hoc basis, by HDSS, and provides:
  answers to common questions recently directed to the HDSS Help Desk
  directives for implementation of revisions to data collection specifications
       (VAED, VEMD, ESIS), including notification of amendments to specified data
       collection reference tables
  feedback on selected data quality studies undertaken, and
  information on upcoming events.


With the introduction of this Bulletin, the ‘Information Updates’ section of the ICD
Coding Newsletter will cease to include material that is covered by the scope of the
Bulletin. Updates relating to coding audits and selected data quality activities,
involving coded data, will continued to be published in this newsletter.


The Bulletins are presently being loaded onto the HDSS website at:
www.dhs.vic.gov.au/ahs/hdss


Wendy Dickins & Sara Harrison




Abbreviations
DHS               Department of Human Services
ESIS              Elective Surgery Information System
HDSS              Health Data Standards and Systems
ICD-10-AM         Statistical Classification of Diseases and Related Health Problems, 10th
                  Revision, Australian Modification
MDC               Major Diagnostic Category
PRS/2             Patient Reporting System 2
VAED              Victorian Admitted Episodes Dataset (name of the admitted patient data
                  collection from 1 July 1999)
VEMD              Victorian Emergency Minimum Dataset
Contents



Coding Features                                      1
 Diabetes With Multiple Complications                1
 Intraperitoneal Chemotherapy                        5
 Preparation For Dialysis                            8
 Victorian Coding Committee’s 20th birthday          9


Information Updates                                 14
 Data Quality                                       14
  Audit of 1998-1999 VIMD Data                      14
  Audit of 1999-2000 VIMD Data                      15


1999 Calendar of Events                             16

On a Lighter Note                                   17

ICD Coding Committee                                18
 ICD Coding Committee Members as at 1 August 1999   18
 ICD Coding Committee Calendar of Meetings          18
Coding Features
Diabetes With Multiple Complications
Compiled by Andrea Groom and Linda Cornell

This Coding Feature seeks to clarify the use of code:
E1x.7x Diabetes mellitus with multiple complications,
following advice provided in June 1999 Coding Matters (page 14). The advice in
Coding Matters is effective for separations from 1 July 1999.


Multiple complications of diabetes is coded to E1x.7x. This code is used instead of
multiple individual E1x.xx codes (thereby overruling the dagger/asterisk
convention). As E1x.7x does not provide detail of the specific complications, the
‘asterisk’ code for each complication is added. It is not necessary to assign specific
diabetes code(s) (E1x.xx) before each complication (asterisk) code.


E1x.7x    Diabetes mellitus, with multiple complications may be assigned as the principal
diagnosis or as an associated diagnosis code, depending on the reason for admission.


If the diabetic complication is the reason for admission, or receives specific treatment
during the admission, these complications should be ‘coded out’, that is assign
specific diabetes codes rather than .7 With multiple complications. Any other diabetic
complications may be ‘bundled’ together using .7 With multiple complications.


Note that the edits regarding the use of multiple asterisk codes without their
corresponding dagger codes have been removed from the VAED.


Example 1
Patient admitted for treatment of a specific diabetic complication, for example
diabetic nephropathy. The patient also has other diabetic complications of
retinopathy and neuropathy. Following ACS 0001 to assign the principal diagnosis
(the reason for admission), the following codes are assigned:


E1x.2x      Diabetes mellitus, with renal complications
N08.3*       Glomerular disorders in diabetes mellitus


E1x.7x       Diabetes mellitus, with multiple complications
H36.0*       Diabetic retinopathy
G63.2*       Diabetic polyneuropathy


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Example 2
If the same patient had ESRF as a complication of the diabetic nephropathy, and was
admitted for treatment of the ESRF (not admitted for preparation for dialysis), the
following codes would be assigned:


N18.0          End-stage renal disease


E1x.7x         Diabetes mellitus, with multiple complications
N08.3*         Glomerular disorders in diabetes mellitus
H36.0*         Diabetic retinopathy
G63.2*         Diabetic polyneuropathy


Refer to the Coding Feature Preparation for Dialysis, page 8.


Example 3
Patient admitted for unstable diabetes. Has diabetic complications of nephropathy,
retinopathy and neuropathy. In this case, as no single diabetic complication is the
reason for admission, E1x.7x may be assigned as principal diagnosis, with a 5th
character of ‘1’ to indicate the unstable diabetes.


E1x.71       Diabetes mellitus, with multiple complications, stated as uncontrolled
N08.3*       Glomerular disorders in diabetes mellitus
H36.0*       Diabetic retinopathy
G63.2*       Diabetic polyneuropathy


Example 4
Patient admitted with uncontrolled diabetes, presenting as ketoacidosis. Patient also
has diabetic retinopathy. The following codes would be assigned:


E1x.11       Diabetes mellitus, with ketoacidosis, stated as uncontrolled


E1x.3x      Diabetes mellitus, with ophthalmic complications
H36.0*       Diabetic retinopathy


Following ACS 0001 the reason for admission is uncontrolled diabetic ketoacidosis.
This is therefore sequenced as principal diagnosis. As there is only one other
diabetic complication, .7 With multiple complications is not assigned, rather the
specific diabetes with ophthalmic complications and diabetic retinopathy codes.




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Example 5
Patient admitted with diabetic hypoglycaemia (as had skipped a few meals). The
patient also required treatment for his infected (pseudomonas) diabetic foot ulcers.
He also has diabetic neuropathy. The following codes would be assigned:


E1x.5x         Diabetes mellitus, with peripheral circulatory complications
L97            Ulcer of lower limb, NEC
B96.5          Pseudomonas as the cause of diseases classified to other chapters
E16.2          Hypoglycaemia, unspecified


E1x.4x         Diabetes mellitus, with neurological complications
G63.2*         Diabetic polyneuropathy


Hypoglycaemia (E16.x) is assigned as an additional code to the diabetes code (Coding
Matters, January 1999).


Example 6
Same patient as in example 5, but in addition has diabetic nephropathy. The
following codes would be assigned:


E1x.5x       Diabetes mellitus, with peripheral circulatory complications
L97          Ulcer of lower limb, NEC
B96.5        Pseudomonas as the cause of diseases classified to other chapters
E16.2        Hypoglycaemia, unspecified


E1x.7x       Diabetes mellitus, with multiple complications
N08.3*       Glomerular disorders in diabetes mellitus
G63.2*       Diabetic polyneuropathy


Example 7
Patient admitted for treatment of diabetic foot so documented (has leg ulcer and
neuropathy). The following codes would be assigned:


E1x.7x       Diabetes mellitus, with multiple complications
L97          Ulcer of lower limb, NEC
G63.2*       Diabetic polyneuropathy


This illustrates another instance where .7 With multiple complications can be the
principal diagnosis code. ACS 0401 Diabetes Mellitus, Diabetic foot (page 72) gives
further detail regarding the coding of Diabetic Foot.




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Example 8
Same patient as in example 7, but in addition has diabetic nephropathy. The
following codes would be assigned:


E1x.7x        Diabetes mellitus, with multiple complications
L97           Ulcer of lower limb, NEC
G63.2*        Diabetic polyneuropathy
N08.3*        Glomerular disorders in diabetes mellitus




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Intraperitoneal Chemotherapy

Compiled by Jodie Miller and Margot Osinski, The Royal Women’s
Hospital

Intraperitoneal chemotherapy is the administration of anti-neoplastic drugs directly
into the peritoneal cavity. This chemotherapy directs a high concentration of the
drug at the peritoneal surface, which can be more effective in the treatment of
localized disease than the usual intravenous route.



Indications for intraperitoneal chemotherapy
It can be difficult to surgically remove all of an intraperitoneal cancer as the cancer
may be widespread throughout the cavity. Therefore, an adjunct therapy such as
chemotherapy is used. Intraperitoneal chemotherapy is not indicated in instances
where it is not possible to achieve an adequate distribution of the drug within the
peritoneal cavity (for example in a patient with extensive intraperitoneal adhesions).


Intraperitoneal chemotherapy may be used for the following conditions:
    Peritoneal carcinomatosis or sarcomatosis
    Peritoneal mesothelioma
    Gastrointestinal cancer
    Malignant ascites
    Advanced ovarian cancer
    Pseudomyxoma peritonei
    Cancer adherent to adjacent organs or structures
    Peritoneal spread/seeding from invasive cancer
    Tumour spill preoperatively.



Method of administration
As repeated access is required to supply the chemotherapy, the patient is fitted with
an implantable peritoneal access device such as a Portacath or Hickman’s catheter.

Insertion of the catheter is a relatively simple procedure which takes place in an
operating theatre and can be performed laparoscopically. The device is inserted into
the peritoneal cavity through a small incision and is not directed into a blood vessel.
(Note that, although the same type of port is used, this should not be confused with
vascular access devices – see ACS 0216 Vascular Access Devices and Implantable
Infusion Pumps). Usually the device employs a different catheter attached to the port.


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The insertion of the peritoneal catheter may take place without the subsequent
administration of chemotherapy during the same episode of care. In this instance,
code:

13109-00 [1061]        Insertion and fixation of indwelling peritoneal catheter for chronic
                       peritoneal dialysis

(The NCCH is considering the introduction of a new, more appropriate, code for the
second edition of ICD-10-AM.)

If the catheter is inserted laparoscopically, also code:

30390-00 [984]         Laparoscopy

(Per ACS 0023 Laparoscopic/Arthroscopic/Endoscopic Surgery).

When the chemotherapy is administered, code:

13948-02 (1784)        Instillation of cytotoxic agent into peritoneal cavity.

Of course, when the catheter is inserted and chemotherapy administered in the same
admitted episode, both procedures are coded.




Care of the catheter
In order to prevent the catheter from becoming blocked, it is periodically flushed
with a solution, usually saline, which contains heparin. Heparin, an anti-coagulant,
prevents blood from clotting inside the catheter. This establishes a ‘heparin lock’.

If the patient is admitted for flushing of the catheter, code:

Z45.8                  Adjustment and management of other implanted device

92195-00 [1893]        Irrigation of catheter, not elsewhere classified

Also code any additional diagnoses (per ACS 0002).

Note that these guidelines are not an instruction to admit patients having their
catheter flushed. If a patient having their catheter flushed is to be reported as an
‘admission’, the hospital should ensure that the criteria for admission are met (see
DHS circular 15/1998).




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Possible complications
Insertion of a catheter for peritoneal access carries the risk of complications
associated with any implanted device or indwelling catheter.

Complications include those of a laparoscopic procedure as well as:
       Catheter occlusion
       Bowel perforation
       Infection
       Leakage
       Haematoma
       Vascular damage


References
Deltec, Sims Deltec Inc, Portacath Peritoneal Implantable Access System, USA
1995.

Kabi Pharmacia, Portacath Implantable Drug Delivery System Patient Information.

Lucas WE, Markamn M, Howell SB, Intraperitoneal chemotherapy for advanced ovarian
cancer. American Journal of Obstetrics and Gynaecology 152(4): 474-478, 1985.

www.surgicaloncology.com/gpmindic.htm, Current indications for cytoreductive
surgery and intraperitoneal chemotherapy.




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Preparation For Dialysis
Coders will have noted that Errata 6 includes changes to the Alphabetic Index of
Diseases (Volume 2), for creation of an arteriovenous fistula (AVF). This directs
coders to use code:


Z49.0 Preparatory care for dialysis


as the principal diagnosis for elective admissions for formation of an AVF for
dialysis only.


Patients admitted electively for insertion of a Tenckhoff catheter or a permacath only
should also have a principal diagnosis of Z49.0.


Patients who are admitted for treatment of their renal failure, and subsequently
undergo formation of an AVF or insertion of a Tenckhoff catheter or a permacath
during their admission (not the reason for admission), would have a principal
diagnosis relating to their renal failure. There is no need to use Z49.0 as an
additional diagnosis in these cases.




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Victorian Coding Committee’s 20th birthday
Irene Kearsey Reflects

The third of a three-part series



The story so far
In the February 1999 ICD Coding Newsletter, I described the events leading to the
establishment of the Victorian Inpatient Minimum Database (VIMD) as this was the
reason to set up the ICD Coding Committee in 1979.


Then in the May 1999 ICD Coding Newsletter, I described the data quality activities
that lead to the establishment of the ICD Coding Committee. In addition, the Terms
of Reference, past and present, were provided and committee members
acknowledged.


In this issue, an overview of the history of the ICD Coding Newsletter is provided.

Authors acknowledged
Many people, too numerous to mention, have contributed to our publications over
the years: please accept our thanks. Remember, if you are interested in preparing a
coding feature or other material to the Newsletter, we welcome contributions.

Early Coding Newsletters
I’ve selected the following items that caught my eye when scanning through older
back issues. Our intention was always for quarterly publication but you will note
from dates and edition numbers that we did not always achieve this.


The first Newsletter (August 1979) was sent to all public hospitals with coders plus
other interested parties (an initial print run of 100 copies). A very simple format:
photocopied pages of typing (this was pre word processing), with a coloured paper
cover, side stapled. A query form appeared as the final page for easy removal and
photocopying. The Newsletter comprised an Introduction and Acknowledgments,
and noted that a copy of the first Official Authorised Errata for ICD-9-CM was
available at Hospital & Charities Commission for reference but not for loan or
copying (remember, the official system was ICD-9). We published twelve queries
and answers, plus some advice issued by WHO London.


In that first Newsletter, we published several pages of amendments and additions to
ICD-9 from a variety of sources (so, nothing new under the sun). Most early


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Newsletters included lists of amendments (errors in the books, omissions, extra
notes, etc); the first Newsletter not to include amendments was edition 14 (March
1986) and only one other issue before 1989 failed to include some amendments.
The second Newsletter (November 1979) included an errata to the first Newsletter
(still nothing new under the sun) and notes on some of the edits applied to codes
(editing of ICD codes started on 1.1.1979 so was still unfamiliar to coders).


The third edition (April 1980) included an Eponym (procedure) supplement: nine
pages printed the same size as the procedure classification for easy fixing into the
books. We included an improved query form designed by Heather Grain. A news
item noted the Australian Bureau of Statistics was approaching other states
encouraging the formation of Coding Committees to ‘contribute to uniformity
throughout Australia’.


The fourth Newsletter (July 1980) included the first coding features (on external
cause codes and on coding deliveries). We also included an article on the newly
established National Perinatal Statistics Unit (our first attempt at keeping coders up
to date with the broad picture).


In the fifth edition (October 1980) we provided an outline of some other, specialist,
ICD-based coding systems (our first information on publications available) and a
supplement on coding deliveries.


The sixth edition (January 1981) announced the Victorian Perinatal Data Collection
and outlined the International Nomenclature of Diseases. For the first time we
included an attempt at something light or humorous but still relevant to the topic.
Over the years, only one complaint about poor taste...


The seventh edition (July 1981) included some notes which a coder could distribute
to clinicians on what information should be in the record for accident patients (for
external cause coding). The amendments to coding books now started to show page
numbers for ICD-9-CM as well as for ICD-9.


In the eighth edition (September 1981) we announced that ‘thanks to the wonder of
word processing, an amalgamated list of all amendments so far published’ was
available on request.




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The ninth (February 1982) and 10th (August 1982) Newsletters reported on
(respectively):
  A paper (given at the Medical Record Association of Australia conference in
    Brisbane) about computerisation of medical records, one part of which was an
    automated coding system; the speaker predicted coders would be out of a job...
  A paper (European Conference on Medical Records, Brighton, England, May
    1982) on an automated coding system.


The 11th Newsletter (February 1983) presented for the first time the average number
of diagnosis and procedure codes per case and the Top Twenty principal diagnoses
and procedures (for the March 1982 quarter). The top diagnosis was ‘Undiagnosed’
(4.5%) even with a very long closure period.



The 12th edition (November 1983) noted that one hospital had reported the
admission of an occupant of a spacecraft (E844.0). We had not achieved full
coverage of public hospitals so were not publishing data but this edition listed a
broad range of data analyses that had been undertaken on request.


After a very long silence, Newsletter 13 (December 1985) outlined various changes
being made to data editing (other than ICD codes) to improve data quality and
provided ABS’s detailed alphabetic index to the two-digit country of birth codes
then being. Such material is not included in the PRS/2 Manual.


The 14th edition (March 1986) confirmed that the date for changing to CM had been
brought forward to 1.7.1986. That edition also included a copy of the guidelines
prepared by Lincoln Institute for their students on procedures to be coded or not
coded (a perennial problem).


For CM, with the American pattern of annual updates, Edition 15 (June 1986) was
the first to include a note about the need to invest in a new edition of the coding
books (something we now take for granted).


A comparison of Regional performance regarding diagnosis outstanding was
included in the 16th edition (August 1986).


Another gap to the 17th Newsletter (May 1987), almost all of which was a list of
amendments to ICD-9-CM for its second year of use. The issue was the first to
mention the impact of Diagnosis Related Groups on medical record departments and
a news item listed the first publications of Victorian data using DRGs.




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Newsletter 18 (January 1988) noted a revision to the morphology code section of the
Library File following advice from Peter MacCallum (morphology codes still
continue to be a trial to Library File compilers).


The 19th Newsletter (March 1988) was a special DRG edition, mainly hints on how
to avoid the problem DRGs.


The 20th edition (October 1988) foreshadowed the problem of introducing new CM
codes but staying with the same grouper (the dreaded mapping...).


A news item in edition 21 (July 1989) quoted a source claiming that ICD-10 would be
introduced in 1993! The issue also included a piece of doggerel ‘Connie the coder’
(with allusions to Con the Fruiterer, to anyone who remembers): Connie lamented
she had only just changed to CM and now people were talking of the coming of 10
(she need not have worried).




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A perennial topic has been diagnoses outstanding. The 7th edition (July 1981) was
the first to cover this. The 22nd edition (November 1989) congratulated public
hospitals on a 99.71% completion rate for diagnoses in the 1988-89 year which closed
6 weeks earlier than the previous year (on 1 October). At the VMRA AGM, the
Department MRAs distributed reward chocolate frogs (we did this for several years,
always at our own expense).


Newsletter 23 (April 1990) noted the interesting statistic that lengths of stay for
episodes remaining undiagnosed were around twice as long as for diagnosed
records.


The 28th edition (September 1991) again highlighted the problem of undiagnosed
records and included a report on the analysis made by Peter Whatley (MRA student
on placement at the Department) of the DRG for ‘procedure unrelated to principal
diagnosis’.


Over the years, the Newsletter’s appearance has improved with access to PCs which
could automatically generate tables of contents and lists. The arrival of various new
brooms has also made a great difference, in particular Shahn Campbell and Ross
Buchanan, and in recent years Wendy Dickins. From the July 1994 issue, the
Newsletter had the generic ‘window’ cover and was comb-bound. The October 1994
edition was the first to include a ‘table of contents’ list of the queries in that issue.
April 1996 was the first issue to include a cumulative index to queries published.


The July 1994 Newsletter noted the establishment in December 1993 of the National
Coding Centre.


The July 1996 issue included a flow chart of our coding query resolution process (13
boxes and some double headed arrows).


In October 1996, the national ICD-10 Implementation Committee was announced.


January 1997 contrasted the field for mechanical ventilation with coding of
mechanical ventilation. A diagram showed calculation of WIES4.


April 1997 provided a calendar of CM and DRG versions used in Victoria 87-88 to
97-98 and an article on ‘DRGs and Casemix Funding’.
July 1997 saw the first ‘Countdown to ICD-10-AM’ column.


Currently, our print run is 350. Distribution has been extended to cover (in addition
to Victorian public hospitals) all Victorian private hospitals, and health authorities,
HIM schools and coding committees in other States. At various times, we have
surveyed recipients to keep the list current.

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And now the Newsletter is on the Department’s Web page. Find it at
www.dhs.vic.gov.au/ahs/hdss. Another thought is to collect the recent coding
features together as a publication in their own right.



Other Publications

Coding Standards
In the first manual for our collection, we included a 21 page chapter ‘Method of
reporting diagnoses, operations, external cause of accidents with specific rulings and
coding decisions’.

1988
A basic guide listing diagnosis codes in code order, showing to which MDC that
code would group as principal diagnosis; for procedure codes, it showed whether
the grouper regarded the code as an O.R. code or not, and those MDCs to which that
procedure could group. The text was cut and paste from a printout kindly provided
by Health Computing Services. A slightly more elegant second edition was
published in July 1990. (Remember, in the early days of DRGs, the little reference
material available was hard to get as well as expensive).

January 1988
Victorian Coding Guidelines for Diagnostic and Procedure Data: some basic rules
(principal diagnosis, principal procedure) and specific coding guidelines.

October 1990
Second edition of Coding Guidelines for Diagnosis and Procedure Data.

January 1992
Third edition of Victorian Coding Guidelines for Diagnosis and Procedure Data.

1992
The Eponyms Booklet, listing diagnosis and procedure eponyms with definitions and
ICD-9-CM codes.

1999
(In preparation) The Eponyms Booklet, listing diagnosis and procedure eponyms with
definitions and ICD-10-AM codes.




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Apologies
In the last issue, somehow Sharon Brown was omitted from the Honours Board of
past and present Coding Committee members. Sincere apologies to Sharon.




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Information Updates
Data Quality

Audit of 1998-1999 VIMD Data

On 9 August 1999, Healthcare Management Advisors (HMA) completed the last of
the hospital audits for the 1998-1999 sample. The Department has been, and will
continue to distribute individual reports to the hospitals involved. Where there is a
Health Information Manager at the hospital, an unbound copy of the report is now
being sent directly to that person, with a copy of the letter to the hospital’s CEO,
who receives a bound copy of the report.


Letters sent to hospitals request a response to the issues raised in the hospital’s
report, and are highlighted in an attachment to the letter. This response is required
within one month of the date of the letter. Where no response is received, this will
be followed up with the hospital. Comments are also invited on the audit process,
and responses will be considered when developing plans for the next round of
audits, to be conducted on data for the 1999-2000 financial year.


A final summary report on the 1998-1999 audit is expected from HMA for
distribution in September. Broad results of the audit of coded data for 5,679 cases at
42 sites, show 4,898 cases (86.25%) grouped to the same AN-DRG. Put another way,
13.75% of that portion of the sample has changed AN-DRG.


This is the first audit where the WIES result for each case has been examined. Of
these cases, 765 (13.47%) have a different WIES6 on audit. Note that some cases
where the AN-DRG has changed will have the same WIES6 (due to the same weight
being applied to different AN-DRGs); and some cases where the AN-DRG is
unchanged will have a different WIES6, due to differences in demographic or
administrative data, such as Indigenous Status. Overall the auditors’ codes result in
an average increase in WIES of 1.12% when compared to the WIES derived from the
original hospital codes.


At the hospital level, percentage changes in WIES6 range from plus 10.63% to -9.25%
(negative values indicate a decrease in WIES6 value after audit). Of the 42 results
available so far, 20 hospitals had a change in WIES6 in the range +/- 2.00%, with a
further 8 hospitals in the range +/- 2.01% to 3.00%.




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Audit of 1999-2000 VIMD Data

Being the second year of the new 2 year audit cycle, data for the 1999-2000 financial
year will be audited in a combination of targets and random samples. A small
number of sites will be selected for audit of a larger sample, based on the results of
the 1998-1999 audit, and a further 40 sites will be selected randomly. Further details
of this next round of audits will be provided in correspondence with hospital CEOs
and in the next edition of publication. Watch this space!



Joanne McLachlan




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        1999 Calendar of Events




           August
            22 - 25      Casemix Conference              Darwin Entertainment Centre
                         ‘The Unfinished Agenda’         Darwin



            September
            22 - 24      NCCH Conference                 Hotel Grand Chancellor
                                                         Hobart
                                                         ph (02) 9351 9461 for details




            October
            12 - 15      16th International Conference
                         of the International Society
                         for Quality in Health Care      Melbourne


            27 - 29      HIMAA Conference                Adelaide Hilton International
                                                         Adelaide




            November
           5             VEMD Forum                      Room B, Level 12
                                                         Department of Human Services
                                                         555 Collins Street
                                                         Melbourne


            26           HDSS Forum                      Royal Children’s Hospital




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On a Lighter Note - Charting
Chuckles!
                                                              Aortic a rte ry

Sup erior
v en a ca va




                                                              Pulmon ary a rte ry




Pulmon ary v eins

                                                              Pulmon ary v eins




                                                              L eft atriu m


                                                              L eft co ron ary a rte ry

R igh t atriu m



                                                              Anterior
                                                              interv en tricu la r a rtery


                                                              Gre at c ard ia c
                                                              v ein
R igh t co ron ary
a rte ry




F at


R igh t ve ntric le




Inferior
v en a ca va




                       Anterior
                       c ard ia c ve in s   D e sc en ding a orta




                                HEART




 Patient has chest pains if she lies on her left side for over a year.
 By the time she was admitted to the hospital, her rapid heart had stopped and she
                      was feeling much better.



                                                                                             Small intestine




 Patient was seen in consultation by the physician, who felt we should sit tight on
                      the abdomen, and I agreed.
 Patient complains of indigestion since last night when he ate a stake.




 When she fainted, her eyes rolled around the room.




 On the second day, the knee was better and on the third day it had completely
                      disappeared.




 Discharge status: alive but without permission.
 The skin was moist and dry.


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                                           http://www.springnet.com Nursing 97, December.




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       ICD Coding Committee
ICD Coding Committee Members as at 1 August
      1999
Irene Kearsey         Convener (Department of Human Services)
Sara Harrison         Minute Secretary (Department of Human Services)
Shannon Watts         Minute Secretary (Department of Human Services)
Jon Agar              Freemasons Hospital
Debbie Brown          Box Hill Hospital
Sharon Brown          Latrobe Regional Hospital
Glenda Cunningham The Angliss Health Service
Andrea Groom          Monash Medical Centre
Kylie Holcombe        St Vincent’s Hospital
Sue Huebner           Ballarat Health Services
Daren Kelm            Melbourne Private Hospital
Mary Ann McCoy        Mercy Private Hospital
Jodie Miller          Royal Women's Hospital
Ruth Rundell          The Geelong Hospital
Jennie Shepheard      Royal Melbourne Hospital


Committee’s representative on VACCDI: Pauline Cripps Box Hill Hospital




ICD Coding Committee Calendar of Meetings
At the Department of Human Services, 10.00 am, 555 Collins Street, Melbourne:
Tuesday 14 September 1999
Tuesday 5 October 1999
Tuesday 9 November 1999
Tuesday 7 December 1999




May Be Reproduced                             ICD Coding Newsletter - August 1999   21

								
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