Changes

statistical Statistical analysis of diseases and therapeutic actions reimbursement; e.g., based on diagnosis-related groups knowledge-based and decision support systems direct surveillance of epidemic or pandemic outbreaks.

<h2>Classification typesTypes</h2>

'''Types of coding systems specific to health care include:'''

<h2>WHO Family of International Classifications</h2>

'''Reference classifications'''

International Statistical Classification of Diseases and Related Health Problems (ICD)[2]

ICD-10-CA (used for morbidity classification in Canada).[3] ICD-10-AM (used in Australia and New Zealand)[4]

International Classification of Health Interventions (ICHI) (previously known as International Classification of Procedures in Medicine)[5]

'''Derived classifications'''

ICD-10 for Mental and Behavioural Disorders[6] Application of the International Classification of Diseases to Dentistry and Stomatology, 3rd Edition (ICD-DA)[7] Application of the International Classification of Diseases to Neurology (ICD-10-NA)[8]

'''Related classifications'''

International Classification of Primary Care (ICPC)[9]

International Classification of External Causes of Injury (ICECI)[10]

Technical aids for persons with disabilities: Classification and terminology (ISO9999)[11] International Classification for Nursing Practice (ICNP)[12]

<h2>Other medical classifications</h2>

 '''Diagnosis'''

International Classification of Headache Disorders 2nd Edition (ICHD-II)[13]

'''Procedure'''

Canadian Classification of Health Interventions (CCI)[14]

'''Other'''

'''Library classification that have medical components'''

<h2>ICD, SNOMED and Electronic Health Record (EHR)</h2>

'''What is SNOMED?''' The Systematized Nomenclature of Medicine (SNOMED) is the most widely recognised nomenclature in healthcare.[15] Its current version, SNOMED Clinical Terms (SNOMED CT), is intended to provide a set of concepts and relationships that offers a common reference point for comparison and aggregation of data about the health care process.[16] SNOMED CT is often described as a reference terminology.[17] SNOMED CT contains more than 311,000 active concepts with unique meanings and formal logic-based definitions organised into hierarchies.[16] SNOMED CT can be used by anyone with an Affiliate License, 40 low income countries defined by the World Bank or qualifying research, humanitarian and charitable projects.[16] SNOMED-CT is designed to be managed by computer, and it is a complex relationship concepts.[15]

The International Classification of Disease (ICD) is the most widely recognized medical classification maintained by the World Health Organization (WHO).[18] Its primary purpose is to categorise diseases for morbidity and mortality reporting. The United States has used a clinical modification of ICD (ICD-9-CM) for the additional purposes of reimbursement. ICD-10 was endorsed by WHO in 1990, and WHO Member states began using the classification system in 1994 for both morbidity and mortality reporting. In the US, however, it has only been used for reporting mortality since 1999. Because of the US delay in adopting its version of ICD-10, it is currently unable to compare morbidity data with the rest of the world. ICD has a hierarchical structure, and coding in this context, is the term applied when representations are assigned to the words they represent.[18] Coding diagnoses and procedures is the assignment of codes from a code set that follows the rules of the underlying classification or other coding guidelines.

'''SNOMED CT vs ICD'''

SNOMED CT and ICD are designed for different purposes and each should each be used for the purposes for which it was designed.[19] As a core terminology for the EHR, SNOMED CT provides a common language that enables a consistent language that enables a consistent way of capturing, sharing, and aggregating health data across specialties and sites of care.[20] It is highly detailed terminology designed for input not reporting. Classification systems such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS group together similar diseases and procedures and organise related entities for easy retrieval.[20] They are typically used for external reporting requirements or other uses where data aggregation is advantageous, such as measuring the quality of care monitoring resource utilisation, or processing claims for reimbursement. SNOMED is clinically-based, document whatever is needed for patient care and has better clinical coverage than ICD. ICD’s focus is statistical with less common diseases get lumped together in “catch-all” categories, which result in loss of information. SNOMED CT is used directly by healthcare providers during the process of care, whereas ICD is used by coding professionals after the episode of care. SNOMED CT had multiple hierarchy, whereas single hierarchy for ICD. SNOMED CT concepts are defined logically by their attributes, whereas only textual rules and definitions in ICD.[20]Data Mapping of SNOMED and ICD

'''Data Mapping of SNOMED and ICD''' SNOMED and ICD can be coordinated. The National Library of Medicine (NLM) maps ICD-9-CM, ICD-10-CM, ICD-10-PCS, and other classification systems to SNOMED.[21] Data Mapping is the process of identifying relationships between two distinct data models. The full value of the health information contained in an EHR system will only be realised if both systems involved in the map are up to date and accurately reflect the current practice of medicine.[18]

Medical coding and classification systems are expected to become increasingly important in the health care sector. Together with and as an integrated part of the electronic health information systems, the coding and classification systems will be used to improve the quality and effectiveness of the medical services.[22]

A standardised classification system, The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), is applied in all Australian acute health facilities. It is based on the World Health Organisation (WHO) ICD-10 system, updated with the Australian Classification of Health Interventions (ACHI), Australian Coding Standards (ACS). Clinical coding is a specialised skill requiring excellent knowledge of medical terminology and disease processes, attention to detail, and analytical skills.[23]

A clinical coder is responsible for abstracting relevant information from the medical record and deciding which diagnoses and procedures meet criteria for coding as per Australian and State Coding Standards. The coder then assigns codes for these diagnoses and procedures based on ICD-10-AM conventions and standards.[23]

The assigned codes and other patient data are processed by grouper software to determine a diagnosis-related group (DRG) for the episode of care, which is used for funding and reimbursement. This process allows hospital episodes to be grouped into meaningful categories, helping us to better match patient needs to health care resources.  ==References== 1. https://www.aapc.com/medical-coding/medical-coding.aspx 2. http://en.wikipedia.org/wiki/Clinical_coder ==See also== [24[Medical Billing]] [[Medical Billing Companies]] [[Category:Medical Coding]]