Filling Feeder Gaps using ICD codes

1. 2008 PPM User Conference Filling Feeder Gapsusing ICD codes Philip Moore

2. Agenda • Overview • Auckland example – Implants • Method in PPM • Exercise – Allied Health • Discussion – other areas

3. Overview • What are feeder gaps? • Why use ICD service codes vs DRG only • How set them up

4. ADHB - Implants • No patient level data available • Obtained data from another DHB with patient level implant data • Adjusted for local practice • Cost by DRG reviewed against National averages

5. Setup in PPM • Service Code Definition • ICD Diagnosis (Coding Diagnosis) • ICD Procedure (Coding Procedure) • ICD Reference Tables • ICD version • Weight File • DRG Weight – Conditional or Unconditional • Detailed Weight

6. Create Service Code • Create a new Service Code • Select Coding Procedure as the Service Code Interface • Click … at Service Code Interface • The Maintain Procedure Service Code Interface Values window • Select the Maintain Selections button

7. Create Service Code • Enter search code at Search String and click Search – Cardiac code • Matching codes display in the list • Tick Create Service Code box and Close • Selected codes will be added to the list • Search again until all the required codes are selected

8. Create Service Code • Set up the service code definition • Include the Procedure or Diagnosis code in the service code to enable easy identification and use of Detailed Weights.

9. Let Me Try “I hear and I forget.I see and I remember,I do and I understand.”Chinese Proverb

10. Exercise – Allied Health • Create new Service Code – Allied Health ICD • Service Code interface – Coding Procedure • Enter search code – 9555 • Select Codes • Social Work – 95550-01 • Physio – 95550-03 • Speech Pathology – 95550-05

11. Exercise – Allied Health • Set up the service code definition • AlliedHealth- • Code • - • DRG • Include the Procedure or Diagnosis code in the service code and DRG • Check Patient Details.

12. Example – Organ Retrievals • Costs related to organ retrievals only allocated to those transplant patients • Previously spread across all patients • Service Code used • GL • Dummy Cost Centre • Reclass rule – Penalty rates etc.

13. Discussion • Other examples • ADHB • Your examples • What other areas? • Continue to try and source patient level utilisation data

14. Thank You Patrick HoranAuckland District Health Board