Leading Clinical Coding Systems of 2020 – An Overview & Comparative Study

November 16, 2020

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Healthcare classification systems are generally used by healthcare providers, quality and management personnel, researchers, other administrative staff (accounting, billing, and coding personnel). They can be used to provide data on costs, treatment options, and outcomes. Information provided by such systems can be used to improve clinical, financial, and administrative performance by enabling effective payment systems, identifying potential fraud and abuse, and ensuring accurate reporting.

In this report, we will talk about 3 such classification systems: the Medicare Benefits Schedule (MBS (Australia), the Australian Classification of Health Interventions (ACHI) (Australia), and Current Procedural Terminology (CPT) (United States).

These systems can support healthcare related entities and they do that through:

  • Providing data on costs, treatments, options and outcomes
  • The information provided can be used to improve clinical, financial and administrative performance by enabling effective payment systems, identifying potential fraud and abuse and ensuring accurate reporting

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Below are examples of classification systems that convey how each differs from their counterparts. It also displays their limitations on the extent their services can reach in terms of what they can cover and what they cannot.

MBS - Medicare Benefits Schedule (Australia)

Purpose
To produce affordable insurance systems that provides basic healthcare to all Australians

Salient features
It’s used as the basis of pricing by the department of veterans affairs of the defence force and their families. It has more comprehensive schedules for dental and allied health services

Countries that use this system:

  •       UK
  •       Sweden
  •       Netherlands
  •       Belgium
  •       Finland
What MBS covers:

Surgery including anaesthesia Yes
Non operating room procedures eg.endoscopies Yes
Dentistry No
Medicine (therapeutic interventions, chemotherapy, radiotherapy) Yes
Evaluation and management (visit professional attendance codes) Yes
Allied Health No
Radiology Yes
Pathology and laboratory Yes


ACHI - Australian Classification of Healthcare Interventions (Australia)

Purpose

Launched as a companion to ICD-10-AM (the international statistical classification of diseases and related health problems, tenth revision)

Salient features

ICD-10-AM, Australian coding standards, standards for the application of ICD-10-AM and ACHI. It continues to maintain a link with MBS through its numbering by considering all new and deleted codes and modifications in each edition of ACHI

Countries that use this system:

  • Saudi Arabia
  • Oman
  • Turkey
  • Singapore
  • Hong Kong

What ACHI covers:

Surgery including anaesthesia Yes
Non operating room procedures eg.endoscopies Yes
Dentistry Yes
Medicine (therapeutic interventions, chemotherapy, radiotherapy) Yes
Evaluation and management (visit professional attendance codes) No
Allied Health Yes
Radiology Yes
Pathology and laboratory No


CPT - Current Procedural Terminology (USA)

Purpose

The purpose was widened to code procedures (mainly surgical) for medical records, insurance claims and information for statistical purposes

Salient features

In the USA it is used for reporting activity, claims processing and developing guidelines for medical review

Countries that use this system:

  • UAE
  • Bahrain
  • South Africa
  • Germany
  • France

What CPT covers:

Surgery including anaesthesia Yes
Non operating room procedures eg.endoscopies Yes
Dentistry Yes
Medicine (therapeutic interventions, chemotherapy, radiotherapy) Yes
Evaluation and management (visit professional attendance codes) Yes
Allied Health Yes
Radiology Yes
Pathology and laboratory Yes


Additional Reading:



Comparisons between classification systems

The table below can help medical providers decide which system would be the best choice by highlighting certain features that might outweigh their counterparts in terms of pros or cons in relation to the needs of the medical provider.

Parameter MBS ACHI CPT
Structure Organised into 8 categories and is divided into groups and subgroups.

 
These groups are organised by practitioner type, procedure type and speciali

Organised into 20 chapters from which 17 are organised by anatomy

 

Each chapter has 4 hierarchical structures :
 - Anatomical Site
 -Procedure Type
 -Procedure Block
 - Procedure  
   Description

Organised into 3 categories

 
Category 1 - core of the 6 systems and organised into six sections

Category 2 - supplementary tracking codes for performance measures, to collect information about care quality delivered

 
Temporary codes covering emerging technologies and service procedures. Can identify services not widely performed by healthcare professionals which includes services that don’t have a US FDA approval


Number of codes
6000
 
Have up to 5 numerical digits
 
Starts with the code 11200 provocative tests for open angle glaucoma including drinking water

6000

Starts with the MBS code but has a 2 digit extension

 Some of ts codes aren’t represented in the MBS and given a code from the 9000 series

10 000

All codes have 5 digits

Category 1 codes are numeric only. Other codes contain a letter as the 5th digit
Applicability to office based or outpatient setting Interventions in:
 
- Hospitals
- Surgery Centers
Interventions in:
 
- Hospitals
- Allied health
   interventions
- Dental services

Interventions in: 

- Office/other
   outpatient services
- Inpatients
- Hospitals

Frequency of update & process Annual Every two years Annual
Training Usually assigned by practitioners rendering the services for which an MBS claim is made

For hospital inpatients, ACHI requires formal training to apply

Requires formal training to apply


Codes in all service settings normally assigned by qualified clinical coders

License MBS can be used outside Australia, and no license is required  Through a licence agreement with IHPA, it comes at a cost The use of CPT is through a licence agreement with the AMA and comes at a cost


Additional Reading:



Comparisons of classification systems using vignettes

Below are examples of real life situations conveying how each of these systems function. Through examining these, medical providers can understand the implications of selecting one in terms of long term strategy and how this might affect their relationship with their customers

Vignette - Routine ECG

A 68 year old man is seen with congestive heart failure is seen for routine ECG with 15 leads. The physician performs the ECG as well interpreting the tests and writing a report

MBS ACHI CPT
11700 Twelve-lead electrocardiography, tracing and report 11700-00 Other electrocardiography 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

 

Vignette - Ear wax removal

A 63-year-old man presented to his family doctor with reduced hearing in one ear following a recent cold. Examination showed a build-up of ear wax in his right ear. The doctor cleaned the wax out of the ear using an ear syringe

MBS ACHI CPT
Part of medical consultation. For a general practitioner, this is 23 Professional attendance by a general practitioner lasting less than 20 minutes 41647-00 Ear toilet, unilateral [Removal of wax (cerumen) from ear, unilateral]. 69209 Removal impacted cerumen using irrigation/lavage, unilateral.

Conclusion

Each of the Coding Systems have their own pros and cons. While, we've offered a summary of the most important points to consider in the article, a more detailed analysis is available in the full report. Please download from the link below.

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Team Accumed

Written by Team Accumed