CLINICAL CODING FOR BM & PBSC TRANSPLANT PROCEDURES

1. CLINICAL CODING FOR BM & PBSC TRANSPLANT PROCEDURES Dr Kim Orchard – Transplant Director Carol Hurlock – Data Manager Wessex Blood and Marrow Transplantation Service

2. Introduction • Discrepancy between WBMTU activity as returned to EBMT and local Patient Administration System (PAS) – ‘coding errors’ • Not just an internal issue of coding – • Central South Coast Specialist Services • Commissioners report on our BMTs • - accessing PAS only

3. Introduction What they thought we did vs what we actually did

4. Introduction • Concerns raised with the BSBMT • How widespread was this problem? • - survey of coding practice in transplant centres

5. Aim • To determine whether transplant procedure coding is consistent across the UK • To establish the codes currently used by UK transplant centres • To raise awareness of the importance of clinical coding for transplant procedures • To present the findings to the BSBMT Executive Committee

6. Plan • Design two questionnaires • One to be completed by the transplant clinician • One to be completed by the clinical coding department within the transplant centre • Questionnaires sent and responses collected by Keiren Towlson on behalf of the BSBMT

7. Process • Both questionnaires sent 27th April 2006 to 56 teams in 53 UK transplant centres • Analyse responses received by 20th Nov 2006 • (following 1 reminder) • Total of 16 clinician questionnaire • responses received • Total of 18 clinical coding department • questionnaire responses received

8. Results: Clinician Questionnaire

9. Results: Coding Dept. Questionnaire

10. Results: Coding Dept. Questionnaire

11. Results: OPCS v4.3 Codes Used BM Harvest • 3 centres use only 1 code which did not reflect a harvest procedure • 11 of 14 use Y667 = Harvest of BM - 9 centres use 2 codes (incl. Y667) to reflect the harvest procedure undertaken - 5 centres use the same 2 codes • 1 centre use 3 codes • adding “1st stage of staged operation” - 1 centre use only Y667

12. Results: BM Harvest • X327 = Leucopheresis • W358 = Introduction bone substance puncture bone therapeutic ( other specified) • W341 = Graft of BM Auto of BM nec

13. Results: PBSC Harvest • 14 of 16 use harvest codes N.B. There is no specific PBSC harvest code - 12 centres use “Harvest of other tissue” - 2 centres use “BM harvest” • 1 centre use “Leucopheresis” only • (same centre as for BM harvest) • 1 centre use “Blood donation”

14. Results: PBSC Harvest - Y361 = Blood donation - Y698 = Harvest of other tissue - Y703 = First stage of staged operation • 8 of 14 centres use the same 3 codes to • reflect PBSC harvest procedure

15. Results: Donor Harvest • 9 of 11 centres use donation and / or harvest codes for BM and PBSC harvest procedures • 1 centre use W341 = Graft of BM - Auto of BM for BM and PBSC (same centre as before) • 1 centre uses X327 = Leucopheresis • for BM and PBSC (same centre as before)

16. Results: Autologous BM Transplant • 13 of 14 centres use W341 = Graft of BM Auto of • BM nec to reflect autologous BM transplant • procedure • 2 centres added Y711 = 2nd stage of staged operations • 1 centre use X338 = Other blood transfusion • other specified

17. Results: Autologous PBSC Transplant N.B. There is no specific autologous PBSC transplant code • 10 of 16 use X338 = Other blood transfusion other • spec and Y711 – 2nd stage of staged operations • 1 centre use code X338 only • 5 centres use W341 = Graft of BM Auto BM nec

18. 10 of 11 centres use W34. codes specific to BM allograft transplant procedures Results: Allogeneic BM Transplant • 1 centre use X468 = Donation of other tissue

19. Results: Allogeneic PBSC Transplant • 5 of 11 centres use X338 = Other blood transfusion • 5 centres use W34. codes specific to BM allograft • transplant procedures • 1 centre use X468 as for BM N.B. There is no specific code for PBSC Allogeneic transplant

20. Summary - 1 • Clinician and clinical coding department • response about their contact with each • other did not correlate • Coding transplant complications in 16 of 18 centres. However, access to case notes occurred in only 14 centres! • Less than half of the centres who • responded validate their EBMT activity • data against their PAS

21. Conclusions - 3 Summary - 2 • 2 centres reported codes for harvest and donor • harvest that do not reflect these procedures • 1 centre reported coding BM and PBSC • autologous transplant as a blood transfusion • 1 centre reported coding BM and PBSC • allogeneic transplant as donation of other tissue

22. Conclusions - 4 Conclusions • BM autologous and allogeneic transplant coding is the • most accurate. • - This is probably due to the fact that there are • specific OPCS codes available • Accuracy of clinical coding for bone marrow and • peripheral stem cell transplant procedures is vital for • both costing and quality purposes especially in a • payment by results system • There is a need for specific national guidance and new • OPCS codes to accurately reflect PBSC transplant • procedures

23. Recommendations • BSBMT to request all UK transplant • centres validate their transplant activity • prior to submission to the EBMT Registry • against PAS • Allocating specific personnel in coding • would improve the consistency of • coding for transplant procedures

24. New Release – OPCS v4.4 X33.4 – Autologous peripheral blood stem cell transplant X33.5 – Syngeneic peripheral blood stem cell transplant X33.6 – Allogeneic peripheral blood stem cell transplant W99 – Graft of cord blood stem cells to BM W99.1 – Allograft of cord blood stem cells to BM