Dilemma of Procedure Code Sets!

TG team faced the Dilemma of Procedure Code Sets while working on Healthcare-IT standards! Given below is a good analysis about lack of opensource procedure code sets globally. A classic example of how developed economies of the world hold emerging economies to ransom!

-- Reproduced from FAQs of MDDS Health Domain Draft Standard --

The mandate of the MDDS was to look for open standards that are currently in use globally. For diagnosis the MDDS has used ICD-10 codes, these codes are map able with the SNOMED.

The Health Domain MDDS Committee reviewed ICD-10-PCS and CPT as a procedure code set options: ICD-10-PCS is an American standard for in-patient procedure codes developed by US Centers for Medicare & Medicaid Services [CMS] not by the WHO. This is an up-gradation from ICD-9-Vol 3, which is also a US standard for in-patient procedures currently in use. USA is set to adopt ICD-10-PCS in Oct/2014 and the licensing terms for ICD-10-PCS will be determined by USA at the time of its adoption in Oct/2014. Also ICD-10-PCS is not a complete procedure coding reference across in-patient and out-patient settings. USA is set to use ICD-10-PCS for in-patient procedure codes, whereas USA uses CPT for out-patient procedure coding. CPT® codes are owned by the American Medical Association [AMA]. The AMA holds copyright on CPT and use or reprinting of CPT in any product or publication requires a license. 

The Committee then reached out to WHO looking for open standard procedure code sets.  The Committee found that WHO is still in the process of developing the initial version of international classification of Health Intervention [ICHI].  WHO says that ICHI is being adapted based on the Australian standards - earlier ICD-10-AM now after the third revision is called Australian Classification of Health Interventions [ACHI].  Quoting the WHO official site:  “In recent years, the Network of WHO Collaborating Centres for the Family of International Classifications has promoted the development of a short list of health Interventions for international use, based on the Australian Modification of the International Classification of Diseases, 10th revision (ICD-10-AM) It is intended to be used in countries that do not, as yet, have their own classification of interventions.  An initial ICHI version is being adapted to meet present day conformance criteria with recognized standards. In particular, the multiple application areas of such a classification calls for a multiaxial capture of the underlying knowledge.” 

For the usage of ACHI the matter was pursued with the concerned Australian dept and the committee was informed that “a country within which you are located must be licensed for the AR-DRG Classification System before being able to purchase any of its materials, including the ACHI”

The Committee then reviewed the Canadian procedure coding standard – Canadian Classification of Health Interventions [CCI] as an alternative. CCI is an open standard and is from a well recognized source which is currently in use. As per CCI code directory: “Contents of this publication may be reproduced in whole or in part for internal, non-commercial use only provided that full acknowledgement is given to the Canadian Institute for Health Information.”

Purpose of coding standards in US such as CPT and ICD is primarily for insurance reimbursement. Whereas purpose of Canadian (CCI), Australian (ACHI) and WHO (ICHI) standards is semantic standardization for analytics, research and policy. ICHI contains approximately 600 codes. However the CCI provides additional level of detail and has more than 17,000 codes.

Considering the complete analysis across – ICD-10-PCS, CPT, ICHI, ACHI and CCI - The Committee found CCI as the only currently used open standard procedure code sets, suitable in Indian context and thus referenced CCI for procedure code sets.

Committee can review the decision in case WHO comes out with a detailed procedure code set under ICHI.