A turkey is  a large bird, one species commonly known as the wild turkey is native to the North American continent, while the domestic turkey is a descendant of this species.

I have never encountered coding for being assaulted by a turkey using ICD 10 in Malaysia. This morning I was amused to find out from a blog that a US legislator, Rep. Ted Poe (R-Texas) was fully aware of the array of ICD 10 codes available for the following conditions, especially the codes available for being assaulted by a turkey:

• Nine codes for being assaulted by a turkey, one code for being assaulted by a turkey for the first time, one code for being assaulted by the turkey a second time etc.
• Five codes for being hit in the face by a basketball; and
• Three codes for being injured by walking into a lamppost.

Poe highlighted these codes in his recent speech when he had criticised the forthcoming ICD 10 medical coding mandate in the US by October 2014. He believes that the level of such detail required for ICD 10 coding “a bit silly”, and would pose challenges for US health care providers.

A check using ICD 10 does not provide codes for the above external cause of injury(s), with such specificity.

But such specificity is provided for in ICD-10-CM.

For example, encounters with a turkey (not necessarily the same turkey) is classified to nine codes, one for “contact with turkey”, one code for “struck by turkey” which has three other codes under this code that describe this diagnosis in greater detail, and one code for “pecked by turkey” which has three other codes under this code that describe this diagnosis in greater detail.

But this is not the same as I think as Poe comprehended based upon his remarks, meaning nine codes assigned for nine encounters of one patient, each of these nine codes assigned for assault by turkey multiple times by one same turkey or different turkeys!

I think it would be absolutely absurd if a patient were to present at a hospital with nine encounters, one after another encounter as a result of assault by a turkey or turkeys, right?

If a patient was struck by a turkey in Malaysia, how would I code to ICD 10. Malaysia does not use ICD-10-CM.

One has to examine Volume 3 of ICD 10 first, to make “clever” (not implying anything here, perhaps “trained” is a better choice of word) decisions in order to assign a near accurate code using ICD 10, unlike my pal in the US using ICD-10-CM. I say “clever” because, you need to find what term(s) define the external cause of injury, which means narrowing down the choice of adjectives defining the lead term(s) for the external cause of injury to search for in Volume 3. I think a good command of the English language is absolutely necessary.

If the doctor had written “struck by turkey” then it would be easy to turn to Section II, Volume 3 and search for the lead term “struck”. Otherwise it is like finding a needle in a hay-stack, searching for the right lead term to look under.

While medical records documentation is not near the desirable quality to expect in most instances, experience in ICD coding will ease this burden when one had encountered such coding problems. However, Health Information Management (HIM) / Medical Records (MR) practitioners still need to examine the entire medical record to find clues to assign an appropriate ICD-10 code in such instances, or simply get back to the attending doctor for help and advice.

So an amateur coder would look under “contact”,  and/or “hit” (which asks to “see Struck by”), and/or “exposure”.  If you look under (i) “contact”, you will find “contact with animal NEC” and the code W64.-., (ii) “hit”, you will find that you are redirected to go to “see Struck by”, and if you look under (iii) “exposure”, there is no find.

So you just go to “struck” for (ii) above or from “hit” to “struck” and your find “animal (not ridden) NEC and the code W55.-

Since birds are also animals like mammals, reptiles, fish and insects, then the turkey is an animal.

So the code is either W55- OR W64.-.

Checking Volume 1, W55.- states the code as “Bitten or struck by other mammals” while W64.- states the code as “exposure to other and unspecified animate mechanical forces”.

A turkey is a bird and not a mammal, so W55.- is not appropriate already, and I am left with W64.- only.

A turkey which strikes a patient must have been agitated, be it either a wild or a domesticated one ( I can only visualise a domesticated turkey in Malaysia, like those bread for poultry at Jitra, Kedah, Malaysia or a patient raring turkeys at his or her home).

So if the turkey strikes at the patient, then it runs towards the patient with mechanical forces using its legs. Thus, its movement is animated, and mechanical, and I would choose to assign the ICD 10 code W64.-, in this case of a patient exposed to a turkey attack or assault which runs towards the patient with animated motion using the mechanical forces of its legs.

From this example it is clear that ICD 10 is not as specific as ICD-10-CM.  That is why ICD 11 is on the way which I think will be more granular that ICD 10.

References:

1. Badriyah Turkey Farm, viewed 15 April 2013, < http://badriyahturkeyfarm.blogspot.com/ >
2. ICD10Data.com, viewed  15 April 2013, < http://www.icd10data.com/Search.aspx?search=turkey&codebook=AllCodes >
3. Kasperowicz, P, Floor Action Blog, The Hill, viewed 15 April 2013, < http://thehill.com/blogs/floor-action/house/292961-lawmaker-rejects-medical-code-mandate-mocks-nine-codes-for-being-assaulted-by-a-turkey >

The Content Model of an ICD entity in the 11th revision of the International Classification of Diseases and Related Health Problems (ICD) forms the basis of this succeeding post to the earlier post ICD 10 & ICD 11 Development – How, What, Why & When (this link will open in a new tab of your current window).

It is not my intention to write volumes on Content Model, rather I shall attempt to share the basics of this model in its simplest form that I have understood as compared to ICD 10.

We know that ICD 10  had evolved to include morbidity classification from its original design to record causes of death. We are aware that ICD is also used for reimbursement (in countries like in the US), and also used in specialty areas such as oncology and primary care.

Then we also know that from the ICD-10 tabular list found in Volume 1, ICD 10 is organised as a monohierarchy. Monohierarchy is a top-down classification. Perhaps the following example of a monohierarchy among Felidae, the biological family of the cats will make things clearer of what I wish to write  about how ICD 10 codes are organised.

ICD 10 uses letters for an initial broad categorisation (e.g., I for diseases of the circulatory system) and combined with digits (e.g. I00 to I02) for each successive level of child codes. Sibling codes (e.g. I01.0 and I01.1) are considered to be exhaustive and mutually exclusive, requiring the use of residual categories—“unspecified” and “other”—at each level, (e.g. I01.9 Acute rheumatic heart disease, unspecified).

A code may have associated inclusions (I10 Essential (primary) hypertension Incl: High blood pressure) and exclusions (e.g. I01.0, Excl: when not specified as rheumatic [I130.-]).

Inclusions are exemplary terms or phrases that are synonymous with the title of the code or terms representing more specific conditions (e.g. I21 Acute myocardial infarction Incl.:myocardial infarction specified as acute or with a stated duration of 4 weeks (28 days) or less from onset).

Most exclusions are either conditions that might be thought to be children of a given condition but, because they occur elsewhere in the classification, must be excluded from appearing under it (e.g. I25.2 for old myocardial infarction); others are codes representing possible co-occurring conditions that should be distinguished from the condition (e.g.I23 Certain current complications following acute myocardial infarction i.e to say co-occuring or concurrent with acute myocardial infarction (I21-I22).

As I have posted in the posts ICD 11 – history of the development of the ICD from 1853 to 2015 (this link will open in a new tab of your current window), ICD 11 is been developed as a participatory Web-based process.

The development of ICD-11 is aimed to create an information infrastructure and workflow processes that utilises knowledge from existing hierarchies of codes and titles found in ICD 10 Volume 1 as I have elaborated above, and supplementary volumes of rules (found in ICD 10 Volume 2) and indices (found in ICD 10 Volume 3).

This new ICD 11 information infrastructure captures the knowledge that underpins the definition of an ICD entity as we know of it today – again as I have elaborated above, which will thus aid the review of best scientific evidences to enable the definition of diseases and health conditions, encoding of the eotiology and the anatomical and physiological aspects of the disease, and mappings to other terminologies and ontologies.

Initially the workflow of the collaborative development of new content and proposed changes, review and approval processes, and the creation of draft classifications for field testing was undertaken by Topic Advisory Groups (TAGs) for various specialty areas.

The workflow continued with the Alpha Draft of ICD-11 revision process with comments and suggestions by interested parties collected in a social process on the Web and  ended by May 2010, and continued with the Beta Draft with field trials of draft standards.

The Alpha and Beta drafts have produced the new ICD 11 information infrastructure based on the Content Model for ICD 11 which represents ICD entities in a standard way, each ICD entity defined by “parameters” representing different dimensions – a parameter expressed using standard terminologies known as “value sets” that specifies the structure and details of the information that should be maintained for each ICD category in the revision process and which thus allows for computerisation.

In the next post, I shall post about the basic structure of the Content Model.

References:

1. International Statistical Classification of Diseases and Related Health Problems, The Tabular List Volume 1 Version 2010, 2010 edn, World Health Organisation, Geneva, Switzerland
2. World Health Organisation, 2012, Content Model, viewed 18 March 2013, < http://www.who.int/classifications/icd/revision/contentmodel/en/index.html >

The World Health Organization (WHO) International Classification of Diseases (ICD) is the global health information standard for mortality and morbidity statistics. ICD (WHO 2012) “is the foundation for the identification of health trends and statistics globally. It is the international standard for defining and reporting diseases and health conditions. It allows the world to compare and share health information using a common language.”

The  version 10 (ICD-10 ) was constructed between 1982-89 and was endorsed in May 1990 by the Forty-third World Health Assembly. In a sense 117 countries around the world, including Malaysia are using a 20-25 year old medical information standard!

An alternative to ICD-10 is the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), used on electronic medical record ontologies to catalog problem lists (diagnosis) of patients.

According to the International  Health Terminology Standard Development Organisation (IHTSDO) which owns, maintains and distributes the SNOMED CT, it claims that “SNOMED CT is the most comprehensive, multilingual clinical healthcare terminology in the world.”

The alpha phase of ICD-11 has been used as the first phase where the development was limited to “in-house”. ICD-11 development is now open to “public” but is not a functional tool yet, ICD-11 is now in beta phase.

The base version of ICD-11 from WHO is expected in May 2015. In the future, there is a proposed merger of sorts between ICD and  SNOMED in ICD-11.

Malaysia, are we ready for ICD-11? Here are some questions we need to find answers. These are known issues, but I think not given much emphasis, direction, motivation,  and mission and vision. Anyways these issues are not peculiar to Malaysia and other countries who have implemented ICD-10 or still using ICD-9  will need to address for continuous improvement.

• Is ICD-10 implemented correctly in Malaysia?
• Who will check the balance between scientific accuracy and completeness?
• Who will continuously monitor by scientific peer review and other quality assurance methods?
• The earliest ICD-11 would be available for study would be let’s say 2017. When can Malaysia implement ICD-11? If ICD-11 is available for example in 2017, would we need another 4 years to implement it? – which brings us out to 2021. What do we do from now 2012 to 2021 – 9 long years more from now or 4 years from 2017 to 2021 or if ICD-11 is ready for adoption in 2015 – 6 years from  2015 to 2021? After all Malaysia only started using ICD-10 in 1999, some 9 1/2 years since May 1990!
• Malaysia is member of the Morbidity Topic Advisory Group (MbTAG) – an ICD-11 Revision committee – Revision Steering Group (RSG). Is there someone or a group preparing Malaysia for ICD-11?

However, let us not forget that there are then several other standards for various disciplines such as Logical Observation Identifiers Names and Codes (LOINC) to think about.  LOINC is a response to the demand for electronic movement of  clinical data from laboratories that produce the data to hospitals,  physician’s offices, and payers who use the data for clinical care and  management purposes.