REFINING ADMITTED AND ACUTE CARE CLASSIFICATIONS IN AUSTRALIA: NOW AND INTO THE FUTURE
Anne Elsworthy a
Introduction
In Australia the Independent Hospital Pricing Authority (IHPA) undertakes the development of classifications across six patient service categories. This presentation will highlight recently finalised new versions of the classifications used in admitted care in Australia, outline a new platform for delivering education and briefly discuss opportunities that ICD-11 may provide in the future.
The following classifications are used in admitted and acute care:- International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM)
- Australian Classification of Health Interventions (ACHI)
- Australian Coding Standards (ACS); collectively ICD-10-AM/ACHI/ACS
- Australian Refined Diagnosis Related Groups (AR-DRGs).
These classifications are not only used in Australia but are also licensed for use in 19 other counties.
ICD-10-AM/ACHI/ACS captures clinical activity in the admitted patient setting and underpins AR-DRGs that group similar admitted acute episodes of care to the resources required in treatment.
Subsets of ICD-10-AM are also used in classifications for the emergency and subacute and non-acute-patient service categories.
IHPA recently finalised the Twelfth Edition of ICD-10-AM/ACHI/ACS and Version 11.0 of AR-DRGs, in consultation with clinicians and health care sector stakeholders in accordance with a governance framework that sets out policies and principles for the development of the classifications.
ICD-10-AM/ACHI/ACS Twelfth Edition
Key updates cover:- coronavirus disease 2019 (COVID-19)
- sepsis and antimicrobial resistance
- outdated mental health terminology
- placeholder codes for new health technology for mid-edition activation
- morphology codes alignment with ICD-O-3.2
- spinal interventions
- stem cell transplantation
- engineered cell and gene therapies.
AR-DRG Version 11.0- new Adjacent Diagnosis Related Groups (ADRGs):
- B08 Endovascular clot retrieval
- F25 Percutaneous Heart Valve Replacement with Bioprosthesis
- G13 Peritonectomy for Gastrointestinal Disorders.
- limiting sex as a grouping variable.
Other refinements have been made for currency using the most recent cost and activity data and cover review of the:- complexity model
- splitting of ADRGs into end classes
- intervention hierarchy
IHPA has recently released interactive online education modules for Twelfth Edition on a new learning management system - IHPA Learn. The eLearning covers major updates in modules that are accessible, interactive, compatible on multiple devices and include quizzes and a certificate of completion.
Education modules for AR-DRG V11.0 are planned for release in August 2022.
What about ICD-11?
In developing ICD-10-AM Twelfth Edition IHPA aligned major updates with ICD-11 where possible. In the next development cycle IHPA will continue to update ICD-10-AM but will likely limit refinements to minor updates given ICD-10 is not being updated by the World Health Organization. Updates to the Australian Coding Standards and the Australian Classification of Health Interventions will continue as usual.
Limiting updates to ICD-10-AM will allow IHPA to invest in projects that will inform decision-makers on when ICD-11 may be suitable for implementation in Australia and include mapping between ICD-10-AM and ICD-11 and exploring opportunities for clustering; the ability to link codes in an episode to provide additional context and meaning.
Conclusions
IHPA will continue to refine and update classifications across different patient service categories and will look to opportunities that ICD-11 may offer to further refine classification development.
a Independent Hospital Pricing Authority, Australia
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