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CLINICAL CODING FOR BM & PBSC TRANSPLANT
PROCEDURES
Dr Kim Orchard – Transplant DirectorCarol Hurlock – Data Manager
Wessex Blood and Marrow Transplantation Service
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
Introduction
year CSCSSC Actual
auto allo auto allo
2003/4
2004/5
2005/6
2
12
3
3
8
10
38
45
41
18
23
20
What they thought we did vs what we actually did
Introduction
• Concerns raised with the BSBMT
•How widespread was this problem?
- survey of coding practice in transplant centres
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
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
Process
• Both questionnaires sent 27th April 2006 to 56 teams in 53 UK transplant centres
• Total of 18 clinical coding department
questionnaire responses received
•Analyse responses received by 20th Nov 2006(following 1 reminder)
• Total of 16 clinician questionnaire
responses received
Results: Clinician Questionnaire
Question Total response
Yes No Comment
Do you or your colleagues have contact with your hospital clinical coding department with regard to the coding of BM and PBSC procedures?
16 2 14 Contact was made monthly for 1 centre and every 6 to 12 months for the other centre
Do you or your colleagues experience any difficulty in obtaining transplant procedure data from your hospital patient administration system?
16 8 6 2 centres had not tried to extract any data from PAS
Is your EBMT transplant activity data validated each year against the data recorded within the hospital patient administration system?
16 5 9 2 centres were not aware if their data was validated
Results: Coding Dept. Questionnaire
Question Total responses
Yes No Comments
Do you have a dedicated person to code BM and PBSC transplant procedures?
18 7 11
Does the clinical coder have access to the hospital case notes to undertake coding of transplant procedures?
16 14 2 Case notes were accessed for coding always in 11 centres and sometimes in 3 centres
Does the clinical coder meet with clinical staff from the transplant team within your hospital?
16 9 7 Contact was made regularly in 2 centres and occasionally in 7 centres
Results: Coding Dept. QuestionnaireQuestion Total
responsesYes No Comment
Has there been any direction sought from your department as to the OPCS codes to use for transplant procedures?
18 11 7 Direction was sought from coding personnel in 4 centres and from clinicians in 6 centres (blank for the other centre)
Have the OPCS codes you currently use for transplant procedures been agreed / signed off by the consultant(s) in transplantation within your hospital?
18 2 16
Are complications coded that occur during the patient’s inpatient episode for transplant?
18 16 2 Complications are coded routinely in 13 centres and occasionally in 1 centre (blank for the other 2 centres)
Results: OPCS v4.3 Codes Used
• 3 centres use only 1 code which did not
reflect a harvest procedure
BM Harvest
• 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
Results: BM Harvest
• X327 = Leucopheresis
• W358 = Introduction bone substance puncture bone therapeutic ( other specified)
• W341 = Graft of BM Auto of BM nec
Results: PBSC Harvest
N.B. There is no specific PBSC harvest code
• 14 of 16 use harvest codes
- 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”
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
Results: Donor Harvest
• 1 centre use W341 = Graft of BM - Auto of BM for BM and PBSC (same centre as before)
• 9 of 11 centres use donation and / or harvest codes for BM and PBSC harvest procedures
• 1 centre uses X327 = Leucopheresis for BM and PBSC (same centre as before)
Results: Autologous BM Transplant
• 2 centres added Y711 = 2nd stage of staged operations
• 13 of 14 centres use W341 = Graft of BM Auto of BM nec to reflect autologous BM transplant procedure
• 1 centre use X338 = Other blood transfusion
other specified
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
Results: Allogeneic BM Transplant
• 10 of 11 centres use W34. codes specific to BM allograft transplant procedures
• 1 centre use X468 = Donation of other tissue
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
Summary - 1• Clinician and clinical coding department response about their contact with each other did not correlate
• Less than half of the centres who responded validate their EBMT activity data against their PAS
• Coding transplant complications in 16 of 18 centres. However, access to case notes occurred in only 14 centres!
Conclusions - 3Summary - 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
Conclusions - 4Conclusions • 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
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
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