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ICD-10-AM 6th Edition Upgrade
Contents
New Zealand hospitals use the coding books produced by the National Centre for Classification in Health (NCCH) hard copy and e-books, 3M Codefinder™ software, NCCH training courses, mapping tables, audit software and coding courses provided by the Health Information Association of Australia (HIMAA) education services.
Historically New Zealand has been at least one ICD-10-AM version behind Australia and it has now been agreed that New Zealand advances to be more in-line with Australia. This decision was made following an extensive consultation process. The Information Liaison Group (ILG) and the Service Framework Group (SFG) agreed to upgrade to ICD-10-AM 6th Edition on 1 July 2008.
Australia presently upgrades every two years and is currently using ICD-10-AM 5th Edition. Upgrading every two years is not desirable for New Zealand because of the costs and resources required for each upgrade. Currently (07/08) New Zealand is using ICD-10-AM 3rd Edition, AR-DRG 5.0 and WIES 11C.
The approved plan for New Zealand Coding Classification Edition upgrades is to move to ICD-10-AM 6th Edition from 1 July 2008. The current version of the AR-DRG, version 5.0 will not change. The new version of WIES will be WIESNZ08 and this will be implemented as part of the 2008 National Collections Annual Maintenance Project (NCAMP).
NZHIS provides six months formal notice of the intended changes being implemented in the following July. The July release can include system changes that have been requested by the System Business Owners and DHBs or are required to be implemented by process changes or legislation. This notice period and its co-ordination is necessary to ensure the health providers, their vendors and the NZHIS system changes are implemented simultaneously ensuring uninterrupted health event data collection and minimal impact to health providers’ work processes. The July release also fits in with the financial year so that there is minimal funding risk to DHBs from mapping or system changes part way through a year. Any such changes are managed through the NZHIS National Collections Annual Maintenance Project (NCAMP).
Changes to ICD-10-AM 6th Edition Codes
Implementing changes to ICD-10-AM codes into NZHIS systems requires changes to all systems that use these codes. Changes are also required for DHB / Software Vendor Patient Management Systems. In addition, Clinical Coder training needs to be provided to ensure coders are fully aware of changes made in each ICD-10-AM Edition.
There are three main components of this upgrade project where the version of the clinical coding classification have changed.
These are:
1. Changes to the national systems at NZHIS to incorporate the new versions of codes
Implementing the new ICD-10-AM 6th Edition into NZHIS systems requires changes to the systems that use these codes. These systems are:
- the National Minimum Data Set (NMDS),
- the National Booking Reporting System (NBRS),
- the New Zealand Cancer Register (NZCR),
- the Mortality Collection,
- the Private Hospital Tool Sets and,
- the Maternity and Newborn Information System (MNIS) data warehouse.
2. Changes to DHB / Software Patient Management Systems to incorporate the new versions of codes
Implementing the ICD-10-AM 6th Edition codes into DHB / Software Vendor Patient Management Systems require changes due to the NZHIS systems that accept these codes. The NZHIS systems are:
- the National Minimum Data Set (NMDS),
- the National Booking Reporting System (NBRS).
3. Providing information and training to support clinical coders throughout NZ
To change coding classifications a whole suite of information needs to be available for the clinical coders throughout New Zealand including coding manuals, coding software and training material to do this.
- An education program specific to the ICD-10-AM Classification upgrade will be organised by NZHIS in collaboration with NCCH
- Facilitation of education workshops and hard copy materials is done by the NZHIS Senior Advisors Clinical Coding Services
- A communication strategy also has to be implemented so that information can be effectively communicated to stakeholders.
ICD-10-AM 6th Edition Upgrade documents
File | Description | Date last updated |
| Proposed upgrade programme paper for: ICD-10-AM | Discussion paper outlining the now approved upgrade (Please note: this is a proposal paper only and therefore it’s likely the upgrade plan and/or dates may differ following the analysis phase). | 30 June 2005 |
| 4th and 5th Edition Description of Differences Summary | Summary of differences in 4th and 5th Editions codes | 12 December 2006 |
| Project Update – memo to District Health Board (DHB) Chief Information Officers (CIOs) | Memo to DHB CIOs providing an update on;
| 14 September 2007 |
| NMDS Change Requirements (sector version) (Word, 731 KB) | Outlines changes to be made to NMDS | 14 December 2007 |
| NBRS Change Requirements (sector version) (Word, 357 KB) | Outlines changes to be made to NBRS | 14 December 2007 |
| Draft Plan for Regional Coder Training Sessions for the ICD-10-AM 6th Edition Upgrade (Word, 44 KB) | Outlines workshops, DHBs/NGOs attending workshops, workshop dates and workshop venues. Please note this plan is for Coders only. Work on training non-coders is currently underway and will be advised in due course | 31 January 2008 |
| 6th Edition Description of Differences Summary (PDF, 91 KB) | Summary of differences between 3rd and 6th Edition codes | 25 February 2008 |
Dates shown below are indicative.
Deliverable | Approximate timeframe |
| Information Liaison Group (ILG) and the Service Framework Group (SFG) agreed to upgrade to ICD-10-AM | Completed |
| Publish analysis of 4th and 5th Edition code changes | Completed |
| Complete impact assessments for each National Collection | Completed |
| Provide sector change requirements (as part of 2008 NCAMP) | December 2007 |
| Publish analysis of 6th Edition code changes | February / March 2008 |
| Confirm Coder training dates and venues | Late 2007 / Early 2008 |
| Complete Coder training | April – June 2008 |
| Complete NZHIS Development and System Testing | May 2008 |
| Provide Compliance test scripts to DHBs (as part of 2008 NCAMP) | May 2008 |
| Compliance environment available for DHBs | June 2008 |
| Complete Compliance testing (as part of 2008 NCAMP) | July 2008 |
| Update and publish NZHIS documentation (data dictionaries, file specifications etc) | 1 July 2008 |
| Changes to National Collections live | 1 July 2008 |
Compliance testing requirements
Prior to implementing the new ICD-10-AM 6th Edition, health providers must test their compliance with the new classification (as part of 2008 NCAMP) before being allowed to commence using them for real Health Events. This process is called Compliance Testing and is usually performed in June, immediately prior to the July implementation. The health provider cannot use the new ICD-10-AM 6th Edition to report discharges to NZHIS until their system has passed Compliance Testing.
Communication
In order to effectively communicate with you, we have established an email user group for the duration of the project, plus published information on the NZHIS website. These communication channels will be used to provide regular updates on progress and further information on the changes. We will also invite questions from the email user group. A Questions and Answers page on the website will be updated regularly. If you have any queries regarding these changes, please contact the project manager by e-mail on david_williams@nzhis.govt.nz using the title 'ICD Upgrade' in the subject line.
Questions and Answers
In order to provide all stakeholders a view of the questions being raised, a list of all the questions received and the appropriate answers will be collated and published (anonymously) on our website on a regular basis, and an email sent to the Email User Group to advise when this is done.
Question: Snomed seems to be the classification of the future, Britain has already started on this and Australia has been heavily involved. HISO and other areas are looking at sharing data for the future and are looking at Snomed as an option. How far away is this for us?
If it is going to change in the next few years it would be pointless to be doing the big jump to 6th edition as this is going to be a major for training and cost for the sector. I am definitely for keeping up to date with the classifications, but it is also important to keep in mind what the future strategic plan may be.
Answer: SNOMED CT® is a terminology, and is fast becoming an internationally accepted health language. It is not and will never be a classification similar to ICD-10-AM. They do different things, they are constructed differently, and they are used for different purposes. However, ICD-10-AM can be mapped to SNOMED CT®, and therefore the two systems can be used together. How this will impact on the future of clinical coding not only in New Zealand but internationally still remains undefined.
The development and uptake of SNOMED CT® in New Zealand does not impact on plans to upgrade to ICD-10-AM 6th edition in 2008. The education involved is being tailor made to be suitable and appropriate for New Zealand coders and will not be dissimilar to past upgrade education in terms of content, scope or cost to the sector. A review of the code differences between 3rd, 4th and 5th edition indicates that the process of this major upgrade, while it might seem overwhelming, will in fact be able to be absorbed by the sector coders as has been done in the past. Planning around supporting coders after the upgrade has occurred is also in place and we are not anticipating any major issues with any of the changes that might impact on the smooth transition of an upgrade.
Question: In regards to the training that will take place in April 2008, will the trainers be going out to regions or are you expecting coding staff traveling to main centres? I would have thought that training would be regional where possible to allow little as possible disruption to staff with young families or other family commitments.
Answer: For the ICD-10-AM 6th Edition Upgrade, we are planning approximately 11 regional workshops and will target areas that have the largest number of coders as best we can to minimise any disruptions. We will advise when our training schedules are available.
Question: Are you yet able to advise which version of AR-DRG we will be using and therefore which edition the code mapping will be done back to?
Answer: There will be no change in the AR-DRG. That is New Zealand will remain on version '5.0' and will not move to version 6.0 until approximately 2010. With regard to your question on 'what edition will the code mapping be done back to'...the answer is, ICD-10-AM 6th Edition will map directly back to ICD-10-AM 3rd Edition and ICD-10-AM 3rd Edition will map directly forward to ICD-10-AM 6th Edition.
Question: Is NZ going to adopt the ‘condition onset flag’ as part of the implementation of Sixth Edition?
Answer: No. There are no plans to implement this as part of the ICD-10-AM 6th Edition Upgrade project. Any decision to adopt this in the future would need to be done with the appropriate consultation.
Question: Will the new code table only have ASCII characters in the code descriptions or will there be ANSI or even UCS? We ask this because currently the NMDS only accepts ASCII, but the current code table includes ANSI characters. This causes events to reject if they have the standard code description. An example of this is Y92.53.
Answer: NMDS currently only accepts ASCII characters. The example you provided for code Y92.53 should not be there and will be removed as part of our code analysis.
Question: When we changed to ICD-10-AM 3rd Edition, a few DHBs were hit with ‘Customs Duties/Tax’ when the books arrived from Australia because of the volume of books that were ordered (our DHB ordered books at that stage and not eBook). Some of us still do prefer books, and I would assume that books would be ordered in by DHBs to at least have one full copy of such on sites, in case of computer down times etc. Therefore could NZHIS look into this, so that we are not hit with the taxes again?
To my knowledge no-one was notified this would happen. Some of us got hefty accounts to pay, and others in the know took on the services of a Customs Broker.
Answer: We have been looking at the Customs website to see if we can find any information on the point you raised. We would suspect that there is no way we can get around the duties/tax as these do apply to the majority of imported goods and the Ministry does not have exemption. We have also had a look at customs brokers and from what we can see, their role is to simply assist in the clearance of goods but again they do not have exemption, so duties/taxes would still apply. We suggest that you build contingency into your budgets to cover these costs.
Question/Concern: There is no large scale ‘train the trainer’ being done this time?
Answer: The issues that were raised after the last upgrade included:
• some regional trainers were not prepared to do regional training
• inconsistency of the training itself by various regional trainers
To address these issues for the 2008 ICD upgrade, we will train the two NZHIS Senior Advisors who will then carry out all regional training. We are planning approximately 11 regional workshops and will target areas that have the largest number of coders as best we can to minimise any disruptions.
Question: Is there an opportunity for trainers to 'sit in' on NCCH training being provided to the two NZHIS Senior Advisors?
Answer: No, we believe that there is little benefit to be gained from 'sitting in' on the initial training as we will be adapting the NCCH training material to best meet NZ coders needs and this will be then be used to provide comprehensive training to coders at the regional workshops.
Question/Concern: The upgrade covers three Editions of ICD-10-AM which is significant.
Answer: We completed analysis of the ICD-10-AM 4th and 5th Edition codes some time ago and made this available on our website so coders have early visibility of these changes. Regional workshops are being planned for up to three days to ensure there is plenty of time to fully cover off changes in 4th, 5th and 6th Editions.
Question/Concern: Last time we were only provided with pre-training material a few weeks prior to training.
Answer: We will be providing training material as early as possible in 2008 to give you time to review this and note any questions you may have. We will allow time to give coders the opportunity to ask questions around the pre-training material and this will help to minimise questions after the implementation of ICD-10-AM 6th Edition codes.
Question: The update letter advised the timeframe for coder training is over three months, can this be reduced?
Answer: We communicated this broadly because we have not yet started planning regional workshops. By having a large window it allows us to consult with DHBs to ensure that training can be scheduled at a time that best suits all parties and to minimise any disruptions. The availability of venues also needs considering.
Question/Concern: Ongoing communication.
Answer: All communication will be coordinated by the Project Manager as the one central contact point. We have a detailed project communication plan and will be providing regular updates and communicating key messages to you through our website and email user group as the main method of communication.
We encourage questions and the Project Manager will ensure that these are answered in a timely manner. Any questions received will be published on our website (anonymously) with the appropriate answers so everyone has visibility of these.
Further to this, we will provide relevant updates through NZCA website and the CCS newsletters.
Question/Concern: Ongoing support.
Answer: As part of our planning for coder training, we will ensure that we have processes in place to address any question you have around the ICD-10-AM 6th Edition codes. As mentioned above, we will allow time to give coders the opportunity to ask questions arising from the pre-training material.
We would expect that regional coding Team Leaders / Trainers would be able to answer many questions using the training material provided and/or coding manuals/eBooks using their own knowledge. However, where they are not able to do so, these would be sent through the NZHIS Senior Advisors to answer. We will advise this process in due course.
If you have any questions regarding these changes, please send them through to the project manager by email on david_williams@nzhis.govt.nz using the title ‘ICD Upgrade’ in the subject line.
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