ICD-10-TM for PCU Implementation in Thailand

1. ICD-10-TM for PCUImplementation in Thailand POLAWAT  Witoolkollachit, MD., M.Sc.(IT-M) Deputy director Tak Public Health office and Bureau of Policy and Strategy Ministry of Public health WANSA PAOIN, MD.,Phd. Faculty of Medicine, Thammasat University

2. ICD Implementation in Thailand • 1950ICD-7 for mortality statistics • 1963ICD-8 • 1980ICD-9 • 1994ICD-10 • 2005ICD-10-TM(ICD-10 Thai Modification)

3. Level of Health Service Providers University Hospitals (Teaching Hospital 500-2000 bed) Center and Provincial Hospitals Community Hospitals Primary Care Units (PCUs)

4. Primary Care Unit (PCU) • Front liner health providers • 10,068 PCUs across the country • Provide preventive care and primary medical care • 3-5 employees/PCUs • Nurses, health workers and public health professionals • NO DOCTOR !!! • 619 Public’s Clinics in Bangkok

5. First evaluation of ICD-10 coding quality in Primary care Unit • Conducted in 2007 • Bureau of policy and Strategy , Ministry of Public Health collected individual patient data coded in ICD-10 from every PCU in the country • Error rates 70-90% • Most common type of error = Invalid code • Second common type = Incorrect code when recheck with diagnosis

6. Cause of error analysis round 1 • No ICD books available in PCU • They use local Diagnosis Name = ICD List • No training on ICD-coding for PCU staff • They ‘ve just select something in the list.

7. รายการรหัสโรคที่พบบ่อยในรายการรหัสโรคที่พบบ่อยใน โรงพยาบาลบ้านหนองหมาว้อ ชื่อโรค รหัส Diarrhea A09 Diabetesmellitus E14.9 ThrombosedHemorrhoid I84.0 Pneumonia J18.9 Bronchitis J40 Lacerationwound T14.1 Fracturefemur S72.9 etc.

8. Training of PCU staff • Feedback from participants • ICD full version is too complicated and too heavy !! • We will hardly found cases to use those codes!! We have common patients with diarrhea, pharyngitis, diabetes mellitus, hypertension etc. • Give me 2-3 copies of ICD book set!! • Give me more people to do ICD coding !!

9. ICD-10-TM for PCU project • Make ICD-10-TM easier for use in PCU • Reduce number of codes by analysis past usage and choose some codes that represent common diseases found in PCU • Eliminate complexity • Dagger – Asterisk system • Hide and seek feature ( Chapter XIII site codes, etc.) • Confusing code description • C00.9 Lips, unspecified • Should be C00.9 Malignant neoplasm of lip • Non user friendly words and symbols • E14.9 Unspecified Diabetes Mellitus

10. Simplified ICD-10-TM • Delete Category header together with some specific code Become A00.9 Cholera

11. Simplified ICD-10-TM • Reduce index terms • Include Self Directed Training book (How to code ICD-10-TM for PCU) in the book set

12. ICD-10-TM Original PCU version ~ 1,900 codes 123 pages of index No complicated features No additional coding Simple words • ~35,000 codes • 401 pages of index • Dagger –asterisk system • Additional codes (option) • Complex words and symbols

17. Implementation of ICD-10-TM for PCU • Testing of beta version July 2009 • Finished first version August 2009 • 1st phase Implementation September - November 2009 • 2nd phase Implementation 2010 • 3rd phase Implementation 2012

19. 3 rd Phase Development in Tak Province • Coding Quality Audit Jan 2013 • Problem Identification, Analysis Feb 2013 • Intervention March – April 2013 • Re Audit June 2013 • Continuous Improvement July 2013

20. Tak Province

21. Tak province ตาก Area16,406.65 Km2. Distance to Bangkok 426 Km. - Border between Thai and Myanmar560 km. - Population 523,956 people

22. แม่ฮ่องสอน เชียงใหม่ ลำพูน ท่าสองยาง ลำปาง สามเงา แม่ระมาด แม่ระมาด บ้านตาก สุโขทัย เมืองตาก แม่สอด Myanmar วังเจ้า พบพระ กำแพงเพชร อุ้มผาง นครสวรรค์ กาญจนบุรี อุทัยธานี Tak Map 9 Districts

23. Coding Quality Audit Jan 2013

24. Type of Coding Errors • A Incorrect Code (Compare to diagnosis word) • B No diagnosis word to support the code • C Ambiguous Code (Silly Codes) (e.g. L02.9 Skin Abscess unknown location) • D Incomplete Code (Loss of Final Digit) • E Use External Cause as Principal Diagnosis • F Code with Too much Digit (e.g. M130005) • G Use ICD code instead of diagnosis word

26. Intervention • Re Training • Adopted new coding guideline • Re Assessment

27. Coding Quality Audit June 2013

28. Continuous Improvement Plan • Set audit team in each district • Conduct audit every 3 months • Identified root cause • Selective correction to individual level • Next external audit Jan 2014

29. Conclusion ข้อเสนอแนะเชิงพัฒนา • Opd implementation • In each opd level มีหมอ ไม่มีหมอ

30. Thank you for your attention