ICD-10 Version Research Articles

Modern Classification of Respiratory Diseases: Innovations in the International Classification of Diseases of the 11th Revision

A comprehensive analysis has been performed on the innovations in the classification of respiratory diseases introduced in ICD-11, comparing it with the previous ICD-10 version. This analysis underscores the critical importance of implementing a more detailed and systematic approach to categorizing diseases of the respiratory system. The enhancements found in ICD-11 have been proven to open up new opportunities for the timely and high-quality provision of medical and pharmaceutical care. This is particularly significant for patients suffering from various injuries, including those resulting from traffic accidents, participation in combat operations, and thoracic injuries. The updated classification system in ICD-11 allows for more precise diagnosis and treatment plans, which is essential for improving patient outcomes. By providing a more granular level of detail in disease categorization, healthcare professionals can better understand the nuances of respiratory conditions. This leads to more effective communication among doctors, pharmacists, and patients, thereby improving the legal and professional relationships within the healthcare system. Integrating the ICD-11 classification into educational and training programs is essential for advancing the qualifications of specialists. By incorporating it into curricula and professional development programs, medical practitioners can stay abreast of the latest advancements in disease classification and patient care. This integration is also vital for eliminating medical errors, as a more detailed classification system reduces the likelihood of misdiagnosis and improper treatment. Furthermore, adopting ICD-11 supports the ongoing development of the healthcare sector in Ukraine. It aligns the country's medical practices with international standards, facilitating better collaboration with global health organizations. This alignment is crucial for enhancing the overall quality of healthcare services provided to the population. In conclusion, the transition to ICD-11 represents a significant advancement in the classification of respiratory diseases. Its implementation is imperative for improving medical and pharmaceutical care, enhancing specialist training programs, and strengthening the doctor-pharmacist-patient relationship. Embracing this updated classification system will not only reduce medical errors but also contribute to the further development of Ukraine's healthcare sector.

The analysis of need in medical care of elder able-bodied women with diseases of blood circulation system

The purpose of the study is to analyze demand in medical care at diseases of circulatory system in women in age groups of 50-64 years old. The database of cases of medical care support of population age groups 50-64 years (the database of calls of Territorial Foundation of Mandatory Medical Insurance of the Moscow region) was used as primary information source. After correlation analysis of dependencies between indicators of demand in modeling, four indicators were left, three of them were volumetric and one frequency. Three blocks were used as basic causes included in Class IX "Diseases of the circulatory system" (ICD-10 version 2014-2016): 1. I10-I15 (Hypertensive diseases [Diseases characterized by high blood pressure]); 2. I20-I25 (Coronary heart disease); 3. I60-I69 (Cerebrovascular diseases). The study demonstrated that dynamics of frequency and volume indicators of medical care demand among women in age groups of 50-64 years testifies that in age range of 50-60 years there is linear or close to linear increase of demand, after which trend of increasing demand changed to downward one. The data obtained testify that age (as variable) explains considerable proportion of all fluctuations of volume of medical care in demand in women of 50-64 years. This result can be considered quite satisfactory for applying proposed model in planning volumes of medical care. It is noted that decreasing of demand increase rate is observed at age of termination of employment of majority of female population.

Effect of COVID-19 on hospital visits and treatments at the Hue University of Medicine and Pharmacy Hospital: An Interrupted Time Series Analysis from 2017 to 2022

Objectives: The research aims to investigate the impacts of COVID-19 on hospital visits and treatments at Hue University of Medicine and Pharmacy Hospital from 2017 to 2022. Methods: A single group interrupted time series (ITS) analysis was employed to assess the effect of COVID-19. The beginning of the intervention was 8 May, 2021 as the first case reporting period, and there were 312 weeks of study, with 224 weeks before and 88 weeks after the intervention. A total number of hospital admissions (visits and treatments) was defined as a dependent variable. It was calculated weekly and described according to the ICD-10 version. A single ITS analysis was calculated to estimate the changes before and after the COVID-19 period. Results: A total of 844.550 hospital visits and treatments were recorded in the hospital, with a mean of 2.707 visits per week. Before the intervention, the mean weekly visits were 2.918, while after the intervention, they decreased to 2.170 per week. Weekly visits and treatments showed a downward trend, with an overall reduction rate of 25,63%. ITS analysis indicated that a total of weekly hospital visits and treatment started at 2758 (β0=2758,44; 95% CI: 2595 – 2921; p<0,001); and a slightly significant increase every week before the intervention point of 1,42 visits (β1= 1,42; 95% CI: 0,10 – 2,76; p= 0,036). In the first week of intervention (week 225), there was a significant decrease in hospital visits and treatment of 1732,72 (β2 =-1732,72; 95% CI: -2170 – -1294); p<0,001); and followed by a significant increase in annual trends of 17,52 ( 95% CI: 10,64 – 21,39; p<0,001). Conclusions: These findings provided scientific evidence of the significant impact of COVID-19 on the disruption of the provision and access to hospital services for the general population.

CONJUGATE ANALYSIS OF HEALTH RISKS IN CHILDREN AND AIR QUALITY IN VLADIMIR REGION

The purpose of this study is to assess health risks in children and the impact of air pollution from industrial enterprises in the Vladimir region on children’s health.
 Materials and Methods. The author analyzed official statistical digests Public Health in the Vladimir Region for 2005–2019. Based on relative data on primary child morbidity according to International Classification of Diseases (ICD-10 version), the values for real (epidemiological) health risks were calculated for Vladimir administrative regions. Data on environmental conditions were obtained from the annual reports On Environmental Conditions and Public Health of the Vladimir Region for 2001–2019. The average long-term emission load coefficient was calculated, and priority air pollutants for the region were identified. To identify probable correlation between air quality and public morbidity, a correlation analysis was carried out to determine the Pearson correlation coefficients and Spearman rank correlation.
 Results. In the Vladimir region, children in most administrative territories have high morbidity risks according to classes of circulatory system diseases; blood, hematopoietic organs, certain disorders involving the immune mechanism (D50–D89) and nervous system diseases (G00–G99). Analysis results revealed administrative territories characterized by very high risk values and the largest number of disease classes. Priority air pollutants in the region are carbon oxide, nitrous oxide, sulphur oxide, methane, ammonia and inorganic dust containing 70–20 % of silicon dioxide. Correlation analysis identified a number of statistically significant correlations between priority pollutants and the morbidity risks in children according to various disease classes. The values of the potential hazard index can be used as variables when carrying out mathematical calculations in the population health - environment system.

The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting.

The International Classification of Diseases ( ICD ) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD ( ICD-10 ), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11 . The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.

Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis.

Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (http://www.w3.org/1999/xlink">osf.io), doi 10.17605/OSF.IO/VFDKW. A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation. Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.

Sling suspension therapy is an effective treatment method of juvenile spinal osteochondrosis in adolescent girls.

Juvenile spinal osteochondrosis (JSO) affects vertebral endplates and may cause intervertebral discs alterations. The condition is typically related to pain, and weakness and shortening of trunk muscles. Sling suspension therapy (SST) has been shown to reduce lumbar pain effectively. It is, however, unclear whether SST is superior to other treatment methods in reducing pain, correcting posture, and activating trunk stabilizers in JSO. In this study, we intended to compare the effectiveness of two different exercise modalities; Sling Suspension Therapy and Gym Ball Exercise in the treatment of JSO in adolescent girls. A randomised controlled single centre clinical trial was carried out in an inpatient rehabilitation unit at a sanatorium. Forty adolescent girls (age 16.3 ± 0.47 yrs.), who were diagnosed with JSO (according to ICD-10 Version: 2016 - M 42.0) were randomly assigned into two groups: Group 1 - Sling suspension therapy (SST), Group 2 - Gym ball exercises (GBE). Both groups received interventions for 3 weeks, 15 sessions, and 30 minutes a day for 5 consecutive days a week. Back pain, endurance of trunk muscles and standing posture were evaluated pre- and post-interventions. Both groups demonstrated significant improvement in all measured outcomes. SST was more effective in reducing pain (p< 0.05), increasing the endurance of trunk muscles (p< 0.05) and improving the standing posture (p< 0.05) compared to GBE (p< 0.05). Sling suspension therapy is more effective compared with Gym ball exercises in the treatment of juvenile spinal osteochondrosis in adolescent girls in terms of back pain, posture and endurance of trunk muscles.

235 Assessing coding of diagnosis for atypical parkinsonian syndromes

BackgroundAtypical Parkinsonian syndromes, including Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA) and Corticobasal Syndrome (CBS), are rare neurodegenerative diseases. Reports showed that the use of the health services for patients with these diseases is underestimated. The NHS uses International Classification of Disease revision 10 (ICD-10) to code health use which has led to error in patient data for these diseases, as they are relatively new entries to this system and there were changes in coding practice in 2016.AimsTo retrospectively investigate the scale of miscoding of PSP, MSA and CBS in England since the introduction of ICD-10.MethodsFreedom of information requests were issued to 150 NHS trusts in England to investigate their method of coding and determine the coding error rate.ResultsThe coding error rates prior to, and after 2016 respectively were: 29.5%, 0% (PSP); 3.8%, 2.3% (MSA); 24.2%, 24.2% (CBS). The indexing for CBS is difficult as no specific coding exists for CBS in ICD-10.ConclusionThe high error rate for PSP is contributed by miscoding of PSP (G23.1) as MND (G12.2), due to the coding techniques employed. These errors have largely been rectified in later versions of ICD-10 with the exception of CBS.ggz1g17@soton.ac.uk

Kelengkapan Informasi Medis Dalam Penetapan Kode Morbiditas, Pada Kasus Chronic Kidney Disease Di Rumah Sakit Panti Wiloso Dr Cipto Semarang

Observations were made on the medical record documents of the Chronic Kidney Disease (CKD) case, found incomplete medical information, namely the results of X-rays of 70%, other tests of 20%, writing of disease history of 10% and some of the stages of disease were not written. The results of the interview with one of the coders were due to the lack of accuracy in filling in medical supporting data. The aim of the study was to describe the medical information in determining morbidity coding in CKD cases. Using a quantitative descriptive research approach, data from observations of 63 documents of CKD inpatient medical records were completed with information from one of the inpatient coder officers. The results showed that, there was still incomplete medical information such as the results of investigations and medical history. And several documents were found whose examination result sheets were not in DRM. The procedure for determining the code in the RS Panti Wilasa Dr Cipto in the CKD case did not differ in giving morbidity codes with other cases. The flow is in accordance with the implementation guidelines for coding in ICD 10 Revision 2010. However, in determining the code the main obstacle is the lack of clarity in writing medical diagnoses, and there is an incomplete history. The conformity of the morbidity code based on ICD-10 version 2010 in the case of CKD in Dr Cipto Panti Wilasa Hospital was 71.42% and the code mismatch was 28.58%. This is due to incomplete medical information and unclear stages of CKD disease. It is advisable for the coder to confirm to the DPJP if there is a diagnosis that is illegible or less specific so that the code generated is appropriate and precise, especially in the diagnosis of CKD. The need to complete medical information and double-check medical record documents before coding. Keywords: Medical Record Documents, Chronic Kidney Diseases, Morbidity Code, ICD-10

Abstract 5778: Hernia and Ewing sarcoma

Abstract Introduction: Ewing sarcoma (ES) is a rare cancer with an incidence that peaks in adolescence and young adulthood. The tumor occurs in bone and soft tissue and the etiology is unclear. Several studies have observed increased ES risk in children and young adults with hernia, including umbilical and inguinal hernia, suggesting a mechanism for a common causal pathway. A meta-analysis of 3 case-control studies reported a threefold increased risk of ES among hernia patients. The purpose of this study is to examine the association between hernia and ES in a population-based study. Methods: We ascertained Ewing sarcoma cases (age &amp;lt;20 years) from the Danish Cancer Registry (diagnoses 1977-2016; births 1977-2013), then randomly selected controls free of cancer at the date of corresponding cases diagnosis and matched (25:1) by sex and year of birth from the Central Population Register (N=4,160). Ewing sarcoma cases (N=122) were identified with the International Classification of Diseases for Oncology (ICD-O-1 and ICD-O-3 code 9260). Information on birth outcomes and gestational factors were taken from the Medical Birth Registry (1973+) and information on mother's and child's health was taken from the National Patient Register (1977+). We also searched this Register for diagnoses of hernia in the child based on procedure codes (a Nordic coding system from 1977-1995, and an extended version of ICD-10 thereafter). We used conditional logistic regression to determine associations for hernia and ES. Results: 122 ES cases were identified, among whom 6 cases had a diagnosis of hernia (1 of them had hernia diagnosed within the first 3 years of life). Among controls, 203 (6.7%) had a diagnosis of hernia. Of all children diagnosed with hernia, 27 (12.9%) presented hernia during the first year of life and 74 (35.4%) presented during the first 3 years of life. In ES cases there was no increase in risk of hernia (OR= 0.53, 0.17-1.72). Adjustment for presence of other congenital malformations did not change the results for hernia (OR=0.65). Restriction to younger cases (diagnosed ≤15 years) showed similar results for hernia. Conclusions: Previous studies have raised the possibility that inherited genes causing both developmental anomalies and cancer might be involved with the etiology of ES. However, based on registry and hospitalization data, we were not able to confirm previous associations with hernia. Either this study or earlier studies may have been influenced by small sample size. There is also a possibility that previous reports of positive associations are due to recall or publication biases. Citation Format: Di He, Johnni Hansen, Noah Federman, Jorn Olsen, Beate Ritz, Julia E. Heck. Hernia and Ewing sarcoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5778.

The Depression Level of Women Suffering Domestic Violence in Medan, Indonesia

BACKGROUND: Domestic violence is defined as a social problem associated with an increased risk of mental illness in women. The violence experienced by women can be a traumatic event that leads to a psychological disorder. Domestic violence has a strong relationship with depression, including depressive symptoms, depression disorders, and suicide. Risk factors associated with depression in women victims of domestic violence are including age, education level, socioeconomic status, and long experience of violence.&#x0D; AIM: The aim of this study was to find the risk factors associated with the level of depression in women who experience domestic violence.&#x0D; METHODS: This was a cross-sectional study and conducted at the Psychiatric Clinic of Dr. Pirngadi General Hospital, Medan. Subjects were 82 people of victims of domestic violence and recruited using non-probability sampling which was consecutive sampling. Subjects that meet the inclusion criteria were interviewed with the ICD-10 (A1) version of the Mini International Neuropsychiatric Interview. Furthermore, subjects were asked to fill out the Beck Depression Inventory-II questionnaire. Finally, statistical analysis was performed using Chi-square and multivariate logistic regression through SPSS software.&#x0D; RESULTS: The most dominant risk factors for the level of depression were categorized with long experience of violence (odds ratio [OR] = 4.939, p = 0.018), economic level (OR = 4.436, p = 0.01), and education level (OR = 3.754, p = 0.022).&#x0D; CONCLUSION: A significant relationship is found between violence duration, economic level, and education level with the level of depression for women victims in domestic violence.

Status poremećaja produžene ožalošćenosti u međunarodnoj klasifikaciji bolesti (MKB-11)

Grief due to loss of a significant other is a universal experience. However, within a small, but a significant group of individuals, this process can last longer than the culturally expected period, and it can be associated with the intense distress, dysfunction, and higher rates of mortality and morbidity. Grief has been observed in the scientific literature as an adaptive reaction to loss, but also as a factor associated with major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder. Previous versions of diagnostic systems, namely DSM-IV and ICD-10, have allocated the phenomenon of prolonged grief as a condition that requires further research, or the condition that requires care. There is a recommendation not to give a diagnosis of a depressive episode because of the normative nature of the reaction to loss. In the new iterations of classification manuals, the ICD-11, this condition is classified as the Prolonged grief disorder. The rationale for change is found in the studies which suggest that this disorder is phenomenologically different from similar states. It aggregates different risk factors and consequences, as well as different treatment solutions. This paper will focus on the criteria of the disorder in the ICD-11 space, researches which mention diagnosis validity, implications, and a broader frame for conceptual and clinical utility of this disorder.

Improving the Quality of Clinical Coding through the Training of Health Records and Information Officers in Selected Hospitals, Nairobi City County, Kenya

Improving the Quality of Clinical Coding through the Training of Health Records and Information Officers in Selected Hospitals, Nairobi City County, Kenya

Mapping ICD-10 and ICD-10-CM Codes to Phecodes: Workflow Development and Initial Evaluation.

BackgroundThe phecode system was built upon the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for phenome-wide association studies (PheWAS) using the electronic health record (EHR).ObjectiveThe goal of this paper was to develop and perform an initial evaluation of maps from the International Classification of Diseases, 10th Revision (ICD-10) and the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes to phecodes.MethodsWe mapped ICD-10 and ICD-10-CM codes to phecodes using a number of methods and resources, such as concept relationships and explicit mappings from the Centers for Medicare & Medicaid Services, the Unified Medical Language System, Observational Health Data Sciences and Informatics, Systematized Nomenclature of Medicine-Clinical Terms, and the National Library of Medicine. We assessed the coverage of the maps in two databases: Vanderbilt University Medical Center (VUMC) using ICD-10-CM and the UK Biobank (UKBB) using ICD-10. We assessed the fidelity of the ICD-10-CM map in comparison to the gold-standard ICD-9-CM phecode map by investigating phenotype reproducibility and conducting a PheWAS.ResultsWe mapped >75% of ICD-10 and ICD-10-CM codes to phecodes. Of the unique codes observed in the UKBB (ICD-10) and VUMC (ICD-10-CM) cohorts, >90% were mapped to phecodes. We observed 70-75% reproducibility for chronic diseases and <10% for an acute disease for phenotypes sourced from the ICD-10-CM phecode map. Using the ICD-9-CM and ICD-10-CM maps, we conducted a PheWAS with a Lipoprotein(a) genetic variant, rs10455872, which replicated two known genotype-phenotype associations with similar effect sizes: coronary atherosclerosis (ICD-9-CM: P<.001; odds ratio (OR) 1.60 [95% CI 1.43-1.80] vs ICD-10-CM: P<.001; OR 1.60 [95% CI 1.43-1.80]) and chronic ischemic heart disease (ICD-9-CM: P<.001; OR 1.56 [95% CI 1.35-1.79] vs ICD-10-CM: P<.001; OR 1.47 [95% CI 1.22-1.77]).ConclusionsThis study introduces the beta versions of ICD-10 and ICD-10-CM to phecode maps that enable researchers to leverage accumulated ICD-10 and ICD-10-CM data for PheWAS in the EHR.

Flexibility of ED surveillance system to monitor dengue outbreak in Reunion Island

Flexibility of ED surveillance system to monitor dengue outbreak in Reunion Island

PS02.231: RELATIONSHIP BETWEEN CHANGE IN TONGUE PRESSURE AND PNEUMONIA AFTER ESOPHAGECTOMY

Abstract Background Esophagectomy for esophageal cancer is a highly invasive procedure with several serious postoperative complications, including pneumonia. It is commonly accepted that deteriorated swallowing function causes postoperative pneumonia. However, measurement to evaluate swallowing function related to postoperative pneumonia has not been developed. Recently, it became possible to measure tongue pressure using a non-invasive, easy and portable device. We hypothesized that tongue pressure relates to postoperative pneumonia. The aim of this study was to investigate the relationship between change in tongue pressure and pneumonia after esophagectomy among inpatients with esophageal cancer. Methods Fifty-eight inpatients (39 males and 19 females; 33–77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure was performed using a portable device before esophagectomy (baseline) and at postoperative 1 and 2 weeks. Repetitive saliva swallowing test (RSST) was also performed to evaluate swallowing function at the same time. Pneumonia was postoperatively diagnosed by the chest X-ray, white blood count, body temperature and purulent sputum. The data of general and oral conditions were collected from medical and dental records. Data also included sex, age, type of cancer, cancer stage (International Classification of Diseases for Oncology ICD-10 version 2015), type of operation (thoracotomy or thoracoscopy), type of preoperative chemotherapy, surgical duration, amount of bleeding during surgery, type of reconstruction, incidences of postoperative complications, intubation period, body temperature, blood chemical analysis, health behaviors and oral condition. Differences in parameters between the pneumonia (+ ) group (n = 10) and pneumonia (-) group (n = 48) were analyzed by Mann-Whitney U or Chi-square test. Level of significance was set at P &lt; 0.05. Results Tongue pressure significantly decreased after esophagectomy (P &lt; 0.05). The decrease in tongue pressure, age, amount of bleeding during surgery, length of fasting days, the ratio of thoracotomy and aspiration in the pneumonia (+ ) group were significantly greater than those in the pneumonia (-) group (P &lt; 0.05). Conclusion The decrease in tongue pressure was related to the incidence of pneumonia after esophagectomy among inpatients with esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Development of the ICD-10 simplified version and field test.

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has been used in various Asia-Pacific countries for more than 20 years. Although ICD-10 is a powerful tool, clinical coding processes are complex; therefore, many developing countries have not been able to implement ICD-10-based health statistics (WHO-FIC APN, 2007). This study aimed to simplify ICD-10 clinical coding processes, to modify index terms to facilitate computer searching and to provide a simplified version of ICD-10 for use in developing countries. The World Health Organization Family of International Classifications Asia-Pacific Network (APN) developed a simplified version of the ICD-10 and conducted field testing in Cambodia during February and March 2016. Ten hospitals were selected to participate. Each hospital sent a team to join a training workshop before using the ICD-10 simplified version to code 100 cases. All hospitals subsequently sent their coded records to the researchers. Overall, there were 1038 coded records with a total of 1099 ICD clinical codes assigned. The average accuracy rate was calculated as 80.71% (66.67-93.41%). Three types of clinical coding errors were found. These related to errors relating to the coder (14.56%), those resulting from the physician documentation (1.27%) and those considered system errors (3.46%). The field trial results demonstrated that the APN ICD-10 simplified version is feasible for implementation as an effective tool to implement ICD-10 clinical coding for hospitals. Developing countries may consider adopting the APN ICD-10 simplified version for ICD-10 code assignment in hospitals and health care centres. The simplified version can be viewed as an introductory tool which leads to the implementation of the full ICD-10 and may support subsequent ICD-11 adoption.

Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options

BackgroundThere is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis.AimTo highlight the current scientific basis of ranula development that informed the preferred surgical approach.DesignRetrospective cohort study.SettingPublic Tertiary Academic Health Institution.MethodA 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken—June 1, 2008–December 31, 2015—from case files retrieved utilising the ICD-10 version 10 standard codes.ResultsTwelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%).ConclusionWith the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.

New ICD-10 version of the Multipurpose Australian Comorbidity Scoring System outperformed Charlson and Elixhauser comorbidities in an older population

ObjectivesTo translate, validate, and compare performance of an International Classification of Diseases, 10th revision (ICD-10) version of the Multipurpose Australian Comorbidity Scoring System (MACSS) against commonly used comorbidity measures in the prediction of short- and long-term mortality, 28-day all-cause readmission, and length of stay (LOS). Study Design and SettingHospitalization and death data were linked for 25,374 New South Wales residents aged 65 years and older, admitted with a hip fracture between 2008 and 2012. Comorbidities were identified according to the MACSS, Charlson, and Elixhauser definitions using ICD-10 coding algorithms. Regression models were fitted and area under the curve (AUC) and Akaike Information Criterion assessed. ResultsThe ICD-10 MACSS had excellent discriminating ability in predicting inhospital mortality (AUC = 0.81) and 30-day mortality (AUC = 0.80), acceptable prediction of 1-year mortality (AUC = 0.76) but poor discrimination for 28-day readmission and LOS. The MACSS algorithm provided better model fit than either Charlson or Elixhauser algorithm for all outcomes. ConclusionThis work presents a rigorous translation of the ICD-9 MACSS for use with ICD-10 coded data. The updated ICD-10 MACSS outperformed both Charlson and Elixhauser measures in an older population and is recommended for use with large administrative data sets in predicting mortality outcomes.

Looking Ahead: Practicing Radiation Oncology in the Era of ICD-10.

For over 30 years, the International Statistical Classification of Diseases and Related Health Problems, 9th edition (ICD9) has provided a framework for medical coding in the United States (1). Beginning October 1, 2015, physicians in the United States are required to begin using the updated, more complex version of this framework for the coding of morbidity: International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). This much-anticipated transition has already occurred in many countries, and as the implementation date has now arrived in the United States, we summarize the changes specific to radiation oncology, highlight implications for future practice and research, and suggest useful references for radiation oncologists. The World Health Organization has been updating the ICD since 1948 (2). ICD-10 represents the 10th edition of this infrastructure. In the United States, ICD-10 was adopted for mortality coding in 1999 (3), but ICD-9 has continued to provide a framework for morbidity coding. The United States adopted 2 versions of ICD-10 on October 1, 2015: ICD-10 Clinical Modification (ICD-10CM), a set of inpatient and outpatient diagnostic codes, replacing ICD-9-CM Volumes 1 and 2, and ICD-10 Procedure Coding System (ICD-10-PCS), a set of inpatient procedure codes, replacing ICD-9-CM Volume 3. The Current Procedural Terminology (CPT) codes assigned to outpatient procedures are not a part of this transition (4). Collectively, ICD-10-CM and ICD-10-PCS will have an impact on diagnostic and procedural coding for all