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Coding News from Clinical Coding Services
New Zealand Health Information Service (NZHIS)

Issue 3

Hi Everyone

This is the third email update to inform you all about what has been happening with Clinical Coding Services at NZHIS over the last few months.

Some of you may be aware Margery Farrant has been appointed to the role of Clinical Coding Services Manager while Tracey Vandenberg is away on parental leave. Margery has previously worked for the Ministry of Health with HealthPAC where she provided senior management services. Prior to that Margery was General Manager of the New Zealand Solution Centre at multinational IT company, EDS, where she led teams that provided IT services to major national and international clients. Margery's career has also included roles at ANZ and Telecom. Margery can be contacted by email: Margery_Farrant@nzhis.govt.nz or DDI: (04) 816 2861.

NZHIS Relocation to 133 Molesworth Street

The move from BCL House, Willis Street to 133 Molesworth Street went well and we have all settled in.

We have now been assigned new phone numbers, so for the next two months people calling old extensions or direct dial numbers will automatically be put through to the new numbers. Please confirm with the person you are calling that you have their correct phone number.

New phone numbers are:
Tracy Thompson DDI: (04) 816 3337
Mary-Ellen Wetherspoon DDI: (04) 816 2830

2005/2006 Full Year Wash-up Cut Off

To confirm and remind you all the full year wash-up cut off date is now Friday 25 August 06.
The original cut off date was Friday 11 August 06, but due to the delay in loading NMDS files at the beginning of the month; a two week extension has been given.

DHBs must get their data into NZHIS by Friday 25 August. The NMDS data extract for the end of year IDF wash ups will be done on Monday 28/Tuesday 29 August following the weekend refresh.

NZHIS Branding (2006)

Jason Whakaari our Group Manager has outlined below what our new NZHIS logo represents and the definition of the Maori insignia.

NZHIS Emblem Logo

The emblem design on the NZHIS Logo represents the various strands of health information that are generated throughout the NZ health sector, being weaved together to form a cohesive fabric of national health information in New Zealand.

As with embroidery materials, the complete value does not reside in the weaving of the strands into a cohesive piece of fabric. Indeed the most significant value is realised when the cohesive fabric is used for a practical purpose, such as providing warmth to the body or for carrying items around.

To this end, the logo emblem is representative of the future direction for NZHIS. NZHIS currently adds value to the sector through weaving together individual strands of health information - to form a cohesive national perspective. Moving forward NZHIS aims to increase utilisation of national health information to support improved health and disability outcomes for all New Zealanders.

NZHIS Maori Insignia (He kupu Maori: Te Pärongo Hauora)

The process to agree on the indigenous Maori name (ingoa) for NZHIS, involved an NZHIS staff member discussing with and taking advice from his tribal elders, with regards to an appropriate name. From a range suggested options tabled, "Te Pärongo Hauora" was settled upon as our relevant Maori name.

'Te' = The
'Pärongo' = Refers to a storehouse of information
'Hauora' = Refers to health and well-being.

The NZHIS Business Plan is now available on the website www.nzhis.govt.nz/aboutnzhis.html. It is a high level plan for 2006/2007 year.

DHB Visits:

To date I have visited 20 DHBs (last DHB to be completed this week), six smaller and five private hospitals and I would like to once again say a big thank you to everyone for their time and for supplying me with the information I requested. The next phase of assessing coder education requirements will be for me to collate and examine all the information collected.

ROLE DEFINITION
I have been asked to clearly outline the roles Mary-Ellen and I fulfill. Below is a brief list of the key areas that we are responsible for. Even though we are responsible for our own key areas we do provide support to each other and participate in some activities together eg, NZCA.

Tracy Thompson, Senior Advisor – Coding Education:

• HIMAA - courses/enrolments
• Coders' Newsletter
• PICQ – implement and distribute reports
• Coders' Regional Education
• Coder Education
• NZCA – meeting minutes
• Classification Upgrade
• Coding queries
• Data quality activities
• Hospital visits

Mary-Ellen Wetherspoon, Senior Advisor - Clinical Coding:

• NZCA – chair meetings and website
• CSAC/NCCH
• Cost Weight Group/Casemix
• Classification Upgrade
• Coding Helpdesk
• Coding queries
• Data quality activities
• Hospital visits

3MTM Codefinder Software Updates

Katrina has provided the information below to be included in this newsletter.

The July 2006 update of 3MTM CodefinderTM Software has been released. Please note that although this update incorporates 5th edition codes for Australia, NZ sites are advised to load the July update and subsequent updates in order to benefit from fixes to 3rd edition pathway issues, enhanced pathways and new features including the NZ Costweight 11A calculator.

On loading the update, your NZ settings will be retained automatically ensuring that discharges post 1st July 2006 will be coded using 3rd edition and will be grouped in V5.0 AR-DRGs. Please be sure to manually select 3rd edition Reference during the install shield wizard.

For further details of the changes in the July update please refer to the 'What's New' document accessible from the Help menu on the Summary Screen.

Any queries may be directed to Katrina Gins, 3M Clinical Support Specialist, on 0800 444 639 or email kngins@mmm.com.

Kind Regards,
Katrina Gins

Contact Wil Bartolomeusz via the help desk, 0800 444 639 for any technical queries.

Weighted Inlier Equivalent Separation (WIES) / Diagnostic Related Group (DRG)

NZHIS provide the official WIES and DRG value for each NMDS event so there may be instances where the DRG and Costweight allocation will be different between the DHBs and NZHIS.

If anyone has queries about the DRG or Costweight NZHIS allocates to an event, contact Angela Pidd or if you have problems getting an event loaded onto the NMDS Angela will also help. Email: Angela_Pidd@nzhis.govt.nz or phone (04) 816 2805.

Admissions to Acute Assessment Units/Emergency Departments

It has come to our attention that some DHBs are not complying with the three hour criteria for emergency department patients. Outlined below is the definition of an admission and the criteria that DHBs have to comply with. Click on link for the admission definition and further emergency department information.
http://www2.moh.govt.nz/QuickPlace/nsfl/Main.nsf/h_Toc/f93eeb4e3361e09dcc25701a0082aa04/?OpenDocument

Admission Definition:

'The administrative documentation process, which will include entry on the NHI, by which a person
becomes an inpatient or day patient of a health care facility.

Health care users who receive treatment for more than three hours or who have a general anaesthetic are to be admitted. This also applies to health care users of emergency departments. When calculating the three hours, exclude waiting time in a waiting room, exclude triage and use only the duration of treatment.

If part of the treatment is observation, then this time contributes to the 3 hours'.

'Treatment' is clinical treatment from a nurse or doctor or other health professional.

Treatment components include: Treatment, therapy, advice, diagnostic or investigatory procedures.

See below for an example of how hours are calculated:

Example:

Patient presents to ED reception desk and is asked to wait in the waiting room, after waiting 25 minutes patient is called into triage where they are briefly assessed and assigned a triage score.
Patient is then asked to return to waiting room until they are called, patient waits a further 35 minutes.

Patient is called into a cubicle to be assessed by a doctor; tests and investigations are requested and undertaken. After an hour and 40 minutes patient receives treatment and is observed for a further two hours, patient is then cleared for discharge from the emergency department and is referred to his GP for follow-up.

Q. Does this patient meet the three hour criteria?
A. Yes – 1 hour 40 minutes + 2 hours = 3 hours 40 minutes (exclude waiting and triage time)

Acute Assessment Unit or Emergency Department patients who meet the three hour criteria should be admitted with the health specialty code of M05 Emergency Medicine.

Birth Events

Reporting birth events:

Numerous duplicate birth events (BT) have been reported to the National Minimum Data Set (NMDS). The duplicate events have occurred due to two different hospitals reporting the birth event. Reporting duplicate birth events occur when the mother is transferred either before or after delivery between the hospital or birth units and both hospital and unit report the birth and delivery.

Only one birth event (BT) can be reported to the NMDS and this should be the hospital where the birth occurred.

The NMDS Data Dictionary states 'Only one birth event is allowed for each NHI number. Babies born before mother's admission to hospital or transferred from the hospital of birth are recorded as IP'.

There have also been events reported to the NMDS with the ICD-10 code Z38.0 Singleton, born in hospital and the event type IP. The ICD-10 codes Z38.0 Singleton, born in hospital, Z38.3 Twin, born in hospital and Z38.6 Other multiple, born in hospital can only be reported on birth events (BT).

Live-born babies:

There are a number of live birth babies born in hospital that later die, not being reported to the NMDS. After contacting the hospitals concerned, it appears there is no birth event generated within their patient management system yet the babies are registered with an NHI number.

The definition of a livebirth is specified below and can be found in the NMDS Data Dictionary.

The World Health Organization definition of a livebirth is:

'The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which after such separation, breathes or shows other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered liveborn.'

All babies born live in hospital must be reported to NMDS as a birth event.

Rehabilitation (AT&R) Process

I have been made aware of some problems occurring with the rehabilitation admitting/discharging process. Clarification of the processes is provided below.

Patients who are admitted with a medical (eg, CVA) or surgical condition (eg, OA with THJR) may require inpatient rehabilitation before being discharged from hospital. In these cases a referral will be sent to the rehabilitation team requesting a patient to be assessed for suitability.

Until such time that the patient has been assessed and the decision has been made to accept the patient for rehabilitation the patient is to remain in the acute ward and under the acute admitting team.

Once the patient has been accepted for rehabilitation the discharge/transfer will then be arranged and the patient will be moved to the rehabilitation ward. The patient will be discharged with the discharge type of DW (discharge to other service within same facility…) from the acute ward and admitted to the rehabilitation ward with a health specialty code from the Dxx section and under the rehabilitation team.

Patients transferring to the rehabilitation ward due to lack of bed space in the medical/surgical ward and who remain under the medical/surgical specialty and team must not be discharged and readmitted. The patient transfer is to be recorded on the patient management system as a transfer not a discharge.

The information and examples below have been taken from the NMDS Data Dictionary:

'DW - Discharge to other service within same facility between the following types of speciality: AT&R, mental health, obstetric, and personal health. Not to be used for transfer between surgical and medical'.

NOTES RE 'DW'
'Discharge type 'DW' is available to be used for any internal transfers between any specialties except Surgical (S) and Medical (M) and vice versa. If the transfer is to another facility (using a different Facility code) then the discharge type 'DT' must be used'. Some examples showing the uses of 'DW' are given below (this is not an exclusive list)':

Assessment, Treatment and Rehabilitation Unit Services
'Inpatient Assessment, Treatment and Rehabilitation (AT&R) care should be able to be identified separately'. That is, all AT&R inpatient episodes of care should result in a discharge for which the Health Specialty Code is Geriatric AT&R (D00-D04), Psychogeriatric AT&R (D20-D24) or Physical Disability AT&R (D40-D44), for the period in which the health care user was under the care of the inpatient AT&R service. 'Health care users can arrive at an AT&R Unit by a number of means'. Three examples follow:

a. 'The health care user is admitted to a health care facility with a medical (eg, acute stroke) or surgical (eg, fractured hip with reduction) problem. If a clinical decision is made to move the health care user to an AT&R unit within the same health care facility, then there must be a discharge from the Medical or Surgical Specialty with an Event end type of 'DW' and an admission to the AT&R unit' with an Admission type of 'AA' arranged admission.

b. The health care user is a Disability Support Service (DSS) resident.
'If the health care user develops a problem which requires AT&R unit services in the same health care facility, they should be discharged from the DSS Specialty with an Event end type of 'DW' and admitted to the AT&R unit' with an Admission type of 'AA' arranged admission.

c. 'The health care user, once admitted to an AT&R Specialty, develops the need for a significant medical or surgical intervention. When this need is above and beyond what would be expected to be delivered in an AT&R Specialty, the health care user should be discharged from the AT&R Specialty with an Event end type of 'DW' and admitted to the appropriate medical/surgical specialty. They may later be discharged (DW) and readmitted to AT&R for post-treatment care'. 'This example would result in three separate inpatient events (and three DRGs) during one continuing episode of inpatient care'.

Please refer to the NMDS Data Dictionary for further information and examples.

For patients admitted as ACC Non-Acute Inpatient Rehabilitation refer to the first Coding Newsletter distributed in March 2006 or refer to the ACC booklet 'Accident Services - Who Pays' available from http://www.acc.co.nz/for-providers/resources/

NCCH

The 10th NCCH Conference will be held in Brisbane, Queensland, Australia from 25-27 July 2007. NCCH are inviting submissions of abstracts now, these must be submitted by Friday 15 December 2006.

For more information visit their website: http://www.fhs.usyd.edu.au/ncch

NCCH Public Submissions

Mary-Ellen has made 14 public submissions on behalf of New Zealand to NCCH for investigation and incorporation into the 6th edition work process. These are shown in the table below with the corresponding NCCH reference numbers.

There are also a number of queries that have been lodged with NCCH that are yet to be addressed. The NCCH task database is managed on a priority/urgency basis; therefore all third edition queries are low in the queue. Interim resolution of queries will be managed at NZCA where possible.

New Zealand Coding Authority (NZCA):

The current NZCA term finished after the face to face meeting that was held in Wellington on Friday 21 July. To finalize the term numerous papers and query resolutions needed to be signed off at this meeting, the papers and queries will then be posted on the website as soon as possible.

Thank you to everyone who provided feedback to Mary-Ellen with regards to the proposed restructure of NZCA. The revised Terms of Reference for the new NZCA have been now signed off.

The revised NZCA Terms of Reference have been designed to give all DHBs, private hospital coders and independent coding contractors the opportunity to be represented on NZCA. Attached is the revised Terms of Reference that includes the new application process. If anyone has any questions or queries about the Terms of Reference or application process contact Mary-Ellen Wetherspoon. Email: mary-ellen_wetherspoon@nzhis.govt.nz

The target to have the new look NZCA website available in July has not been met. Jonathan Ball (Desktop Publisher) has left NZHIS and his replacement is Vicki Brimilcombe. Vicki is now familiar with the processes, format and requirements for the site and is currently working on updating it.

ICD-10-AM Classification Upgrade

NZHIS has started the analysis work for the ICD-10-AM upgrade to the 6th Edition. Gary Lawn has been brought on as a Senior Business Analyst to initially complete the high level analysis, followed by a more detailed analysis to look at the impacts on systems and data. It is expected that the detailed analysis will take approximately four months and we'll keep you informed of progress as this work continues.

All questions and enquires are to be directed to David Williams, Project Manager.
Email: David_Williams@moh.govt.nz

Well that's all from me for now and I hope to catch up with some of you at the HIANZ study day in Hamilton on Friday 28 July.

NOTE: Where it is appropriate to forward any of the above information onto other people within your DHB, please do so.

Tracy Thompson
Senior Advisor - Coding Education
Clinical Coding Services
New Zealand Health Information Service
Corporate & Information Directorate
Ministry of Health
DDI: 04 816 3337
Mobile: 027 270 4491
Fax: 64-4-816-2897

http://www.nzhis.govt.nz
mailto: Tracy_Thompson@nzhis.govt.nz

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