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PubMed1996

Preoperative imaging of lower extremity varicose veins: color coded duplex sonography or venography.

We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.

Adult↗

PubMedDate not supplied

Accuracy of CPT evaluation and management coding by family physicians.

BACKGROUND: Limited data are available on physicians' accuracy in coding for their services. The purpose of this study was to determine the current procedural terminology (CPT) evaluation and management coding accuracy of family physicians and define demographic variables associated with coding accuracy. METHODS: Six hundred randomly selected active members of the Illinois Academy of Family Physicians were sent six hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT evaluation and management codes to each of the progress notes and completed the demographic survey. Five expert coders also assigned codes to each of the cases. The accuracy of family physicians in determining CPT E/M codes was determined relative to that of expert coders. RESULTS: Family physicians agreed with the experts' CPT evaluation and management codes for 52% of established patient progress notes, the most common error being undercoding. In contrast, for new patient progress notes, family physicians agreed with the experts only 17% of the time, the predominant error being overcoding. No surveyed demographic variable was associated with coding accuracy. CONCLUSIONS: The error rate for physician CPT coding is substantial and occurs more commonly with new patients. The complexity of the CPT coding guidelines, along with limited physician training in CPT coding, likely account for these results.

Ambulatory Care↗

PubMed2004

Quality of diagnostic coding and information flow from hospital to general practice.

AIMS: To describe the transfer of patient information from hospital to general practice and compare the quality of coding of patient diagnoses in hospital and general practice systems. METHOD SETTING: Wellington Hospital and patients registered with 12 general practitioners (GPs) from two local computerised general practices. Discharge and outpatient letters for the period June to August 2003 were analysed and diagnostic coding compared between letters and electronic health records (EHR) in hospital and general practice. A questionnaire was sent to 167 consultants and 112 GPs from Wellington city region with a 71% response rate. RESULTS: GPs received 55% of 284 discharge letters and 97% of 612 outpatient letters with a mean time of 9.4 days (range 0-70 days) and 14 days (range 0-120 days). The mean number of diagnostic codes recorded in discharge letters was 2.9 per letter, in the GPs' EHR 0.9 per letter, and in the hospital EHR 3.5 per letter. GPs were sent new diagnostic information in 30% of discharge and 36% of outpatient letters. There was more coding agreement between GPs' EHR and discharge letters than between the hospital EHR and discharge letters (65% versus 35%). GPs duplicated coding for 71% of all letters, and 74% of diagnoses were coded within the classification section of the GPs' EHR. More GPs than hospital doctors coded patient diagnoses (85% versus 15%), had any formal training in coding (25% versus 2%), and thought coding improved patient care (75% versus 50%). Most doctors in both groups experienced considerable delay of information flow and favoured an electronic transfer of information. CONCLUSIONS: There is delay in information flow from hospital to general practice and poor comparison of diagnostic coding across the two systems. Attitudinal differences and inefficient coding practices will need to be addressed to produce an integrated information system between hospital and general practice.

Adolescent↗

PubMed2001

Role of correct coding for interventional techniques.

There has been enormous emphasis on the description and definition of what the physician does for and to the patient, with fraud and abuse evolving as an important aspect of interventional pain medicine. Compliance with the laws and regulations encompassing documentation with coding, billing, and collections, and medical records, is crucial in today's interventional pain medicine practices. The Health Insurance Portability and Accountability Act of 1996, provided the Office of Inspector General and the Federal Bureau of Investigations with broad powers and directed them to identify and prosecute health-care fraud and abuse. The National Correct Coding Council was created by Centers for Medicare and Medicaid Services to help ensure that providers across various jurisdictions receive like payments for the same services, use the same codes and provide similar documentation for services performed. As a direct outgrowth of the National Correct Coding Council's work, the Centers for Medicare and Medicaid Services established the National Correct Coding Policy in 1996 and eventually implemented the Correct Coding Initiative (CCI) to identify and isolate inappropriate coding, unbundling, and other irregularities in coding. Multiple versions of National Correct Coding Policies have been released in the form of National Correct Coding manuals ranging from version 5.0 to 7.2. This review discusses various aspects of correct coding in interventional pain medicine.

Journal Article↗

PubMed1994

Automatic SNOMED coding.

Medical coding has become an important new industry that has originated from the field of medical informatics. Automatic coding of specimens has emerged as a way of relieving hospitals from the cost of paying professional coders and for achieving uniform coding for all specimens. Unfortunately, automatic coding, like manual coding, has numerous pitfalls. Further, the coding algorithms employed by manufacturers of automatic coders are typically proprietary. We have developed a method for automatic coding of pathology reports. Using this public domain autocoder, we have previously demonstrated that automatic SNOMED coding was superior to manual coding in several measurable categories, including the overall number of codes generated and the number of distinct code entities provided. In this report, we describe an algorithm that executes this strategy in the M-Technology environment.

Algorithms↗

PubMed1998

Limits of ICD-9-CM code usefulness in epidemiological studies of contact and other types of dermatitis.

BACKGROUND: International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) coding information used for billing is readily available in computerized form. OBJECTIVES: The purpose of this article is to determine the usefulness of ICD-9-CM codes in a descriptive dermatoepidemiological study of contact and other dermatitis. METHODS: Prospective recording of specific dermatologic diagnoses and the ICD-9-CM code assigned for each diagnosis was performed for all patient visits to the author's dermatology clinics for 6 months. RESULTS: There were 2,524 patient visits with 4,451 diagnoses, of which 789 diagnoses were dermatitis. The 10 different diagnostic categories of dermatitis had eight associated ICD-9-CM codes. Allergic contact dermatitis with 247 visits, irritant contact dermatitis with 30 visits, and nummular dermatitis with 61 visits shared one diagnostic code. Thus, 43% of visits for dermatitis were intermixed by having the same ICD-9-CM code. CONCLUSION: Lack of one-to-one correspondence of ICD-9-CM codes with dermatitis diagnostic categories creates a situation in which ICD-9-CM codes are not useful for dermatoepidemiological studies of contact and other types of dermatitis. This could be corrected by assigning additional five-digit ICD-9-CM codes to cover each type of dermatitis. Coding for specific allergens or irritants is not feasible with the current five-digit ICD-9-CM codes.

Adult↗

PubMed1994

The origin and evolution of the genetic code.

We argue that a primitive genetic code with only 20 separate words explains that there are 20 coded amino acids in modern life. The existence of 64 words on the modern genetic code requires modern life to read almost exclusively one strand of DNA in one direction. In our primitive code, both the original and the complementary sequence are read in either direction to give the same strings of amino acids. The algebra of complements forces synonymy of primitive codons so as to reduce the 64 independent codons of the modern code to exactly 20 independent separate words in the primitive condition. The synonymy in the modern code is the result of selection rather than algebraic forcing. The primitive code has almost no resilience to base mutations, unlike the third base redundancy of the modern code. Our primitive and the modern code are orthogonal. If palindromic proteins were coded by hairpin DNA or RNA, then (i) no punctuation would be needed; (ii) the reverse reading would give the same secondarily folded protein structure; and (iii) the sugar backbone would be read in the conventional 5' to 3' direction for the original arm and its complement. Modern copying of genetic material is almost always antiparallel. However, occasional parallel copying, as does occur in modern life, would give the complementary hairpin that would also read 5' to 3' along its entire length.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗

PubMed1987

Phases of degeneracy of the genetic code.

The universally valid genetic code is the final result of a multi-stage course of development. Degeneracy, as an important property of the genetic code, was possibly not yet present in the earliest code, first appearing at a later stage of development (Code III). Possibly this step in development is coupled with the presence of a total of four amino acid groups (L, I, E, F). Each group contains a specific number of amino acid (AL, AI, AE, AF). Amino acid groups: - (L) hydrophobic - (I) weakly hydrophobic or polar but uncharged - (E) hydrophilic, acidic - (F) hydrophilic, basic - (D) hydrophobic, aromatic (only in Code IV and Code M. This group is not considered in the calculations below.) In a subsequent stage of development the number of amino acids increases further. At the same time the code becomes more degenerate. The universal genetic code is characterized by three constants of being degenerate. Its immediate predecessor has linear degeneration with two constants. The mitochondrial code represents a transitional form between these two codes.

Amino Acid Sequence↗

PubMed1998

On error minimization in a sequential origin of the standard genetic code.

Distances between amino acids were derived from the polar requirement measure of amino acid polarity and Benner and co-workers' (1994) 74-100 PAM matrix. These distances were used to examine the average effects of amino acid substitutions due to single-base errors in the standard genetic code and equally degenerate randomized variants of the standard code. Second-position transitions conserved all distances on average, an order of magnitude more than did second-position transversions. In contrast, first-position transitions and transversions were about equally conservative. In comparison with randomized codes, second-position transitions in the standard code significantly conserved mean square differences in polar requirement and mean Benner matrix-based distances, but mean absolute value differences in polar requirement were not significantly conserved. The discrepancy suggests that these commonly used distance measures may be insufficient for strict hypothesis testing without more information. The translational consequences of single-base errors were then examined in different codon contexts, and similarities between these contexts explored with a hierarchical cluster analysis. In one cluster of codon contexts corresponding to the RNY and GNR codons, second-position transversions between C and G and transitions between C and U were most conservative of both polar requirement and the matrix-based distance. In another cluster of codon contexts, second-position transitions between A and G were most conservative. Despite the claims of previous authors to the contrary, it is shown theoretically that the standard code may have been shaped by position-invariant forces such as mutation and base content. These forces may have left heterogeneous signatures in the code because of differences in translational fidelity by codon position. A scenario for the origin of the code is presented wherein selection for error minimization could have occurred multiple times in disjoint parts of the code through a phyletic process of competition between lineages. This process permits error minimization without the disruption of previously useful messages, and does not predict that the code is optimally error-minimizing with respect to modern error. Instead, the code may be a record of genetic process and patterns of mutation before the radiation of modern organisms and organelles.

Amino Acids↗

PubMed2003

Arithmetic inside the universal genetic code.

The first information system emerged on the earth as primordial version of the genetic code and genetic texts. The natural appearance of arithmetic power in such a linguistic milieu is theoretically possible and practical for producing information systems of extremely high efficiency. In this case, the arithmetic symbols should be incorporated into an alphabet, i.e. the genetic code. A number is the fundamental arithmetic symbol produced by the system of numeration. If the system of numeration were detected inside the genetic code, it would be natural to expect that its purpose is arithmetic calculation e.g., for the sake of control, safety, and precise alteration of the genetic texts. The nucleons of amino acids and the bases of nucleic acids seem most suitable for embodiments of digits. These assumptions were used for the analyzing the genetic code. The compressed, life-size, and split representation of the Escherichia coli and Euplotes octocarinatus code versions were considered simultaneously. An exact equilibration of the nucleon sums of the amino acid standard blocks and/or side chains was found repeatedly within specified sets of the genetic code. Moreover, the digital notations of the balanced sums acquired, in decimal representation, the unique form 111, 222...., 999. This form is a consequence of the criterion of divisibility by 037. The criterion could simplify some computing mechanism of a cell if any and facilitate its computational procedure. The cooperative symmetry of the genetic code demonstrates that possibly a zero was invented and used by this mechanism. Such organization of the genetic code could be explained by activities of some hypothetical molecular organelles working as natural biocomputers of digital genetic texts. It is well known that if mutation replaces an amino acid, the change of hydrophobicity is generally weak, while that of size is strong. The antisymmetrical correlation between the amino acid size and the degeneracy number is known as well. It is shown that these and some other familiar properties may be a physicochemical effect of arithmetic inside the genetic code. The "frozen accident" model, giving unlimited freedom to the mapping function, could optimally support the appearance of both arithmetic symbols and physicochemical protection inside the genetic code.

Amino Acid Sequence↗

PubMed2006

Ethical codes in nursing practice: the viewpoint of Finnish, Greek and Italian nurses.

AIM: This paper is a report of a study exploring the use of ethical codes and obstacles to their use in nursing practice as perceived by Finnish, Greek and Italian nurses. BACKGROUND: In all European countries nurses are responsible for the well-being of patients, for their own technical and ethical competence and, for their own part, for the high standard of health care in society. These points illustrate the central content areas of nursing codes of ethics. Recent advances in medical technology have added to the complexity of nursing. Nurses today are increasingly confronted with ethical dilemmas, underlining the role and meaning of ethical codes in their decision-making. However, there is only very limited research literature on codes of ethics, their use in nursing practice and obstacles to their use. METHODS: Twenty-three focus group interviews were conducted in 2003 with a total of 138 Registered Nurses: 35 in Finland, 54 in Greece and 49 in Italy. The data were content analysed. FINDINGS: Two main categories emerged from our analysis of the use of ethical codes: (1) conscious and (2) unconscious use. Seven main categories described the obstacles to the use of ethical codes: (1) the codes themselves, (2) nurses themselves, (3) multiprofessional teamwork, (4) patients' family members, (5) the organization, (6) the nursing profession and (7) society/healthcare policy. Participants in all three countries were firmly committed to the values expressed in ethical nursing codes. Nonetheless, continued efforts are needed in all these countries to remove the remaining obstacles so that nursing care can be provided in keeping with the requirements of ethical codes. CONCLUSION: The use of codes is connected with the changes in nursing profession and in society at large. The core of nursing, however, has remained stable. Future studies should be conducted in order to generalize the findings to a broader population.

Adult↗

PubMed2004

A survey of clinical productivity and current procedural terminology (CPT) coding patterns of pediatric hematologist/oncologists.

BACKGROUND: Subspecialty-specific normative values for clinical productivity of practicing pediatric hematologist/oncologists have not been well established. This information could be a useful adjunct in administrative decision-making in areas such as necessary levels of physician staffing and development of compensation plans. METHODS: Current procedural terminology (CPT) coding information was obtained from 27 pediatric hematology/oncology groups. Clinical productivity was assessed by overall number of patient encounters and the total number of physician work relative value units (RVU) as defined by the resource-based relative value scale. The average physician productivity within each individual program was calculated. To determine uniformity of CPT coding, an additional survey solicited mock patient encounter documentation and CPT coding for a simple clinical vignette. RESULTS: A broad range of clinical productivity was observed for both numbers of patient encounters and RVU. Evaluation of the CPT coding data of the surveyed groups revealed differences in usage of certain evaluation and management (E/M) codes and procedural and specimen interpretation codes. Within individual categories of E/M service codes, a wide variation in assigned CPT code levels was also observed. This observation was supported by differences in the E/M coding for the clinical vignette. CONCLUSIONS: Assessment and tracking of physician productivity can provide useful information for the administrative management of pediatric hematology/oncology programs. Caution must be exercised, however, when making productivity comparisons with other subspecialties or even between pediatric hematology/oncology programs. Such comparisons should take into account the number of patient encounters, characteristics of E/M coding patterns, the use of physician extenders, as well as overall RVU production.

Current Procedural Terminology↗

PubMed2001

Effective coding in birth defects surveillance.

Effective coding is critical to data collected by birth defects surveillance programs because subsequent use of the data depends on storage and retrieval of cases using codes. Hence, careful consideration needs to be given to the coding process. The primary goal of coding is to accurately, completely, and concisely represent infants with birth defects. Coding procedures need to accommodate the objectives of the surveillance program; for example, programs that focus on research may require different coding procedures from those that focus on linking infants to services. Several challenges exist in coding birth defects, including the need to distinguish infants with multiple defects and syndromes from those with isolated defects, and the need for strategies to code suspected defects for which confirmation is not available. Selection of a coding system by a birth defects surveillance program is central to the utility of the data collected. Most programs use a modification of the International Statistical Classification of Diseases and Related Health Problems-based (ICD) systems. This paper addresses ICD-based systems and the modifications used by many birth defects surveillance programs and presents examples of the problems in interpreting birth defects data because of inappropriate coding.

Congenital Abnormalities↗

PubMed2004

Orientation-contingent face aftereffects and implications for face-coding mechanisms.

Humans have an impressive ability to discriminate between faces despite their similarity as visual patterns. This expertise relies on configural coding of spatial relations between face features and/or holistic coding of overall facial structure. These expert face-coding mechanisms appear to be engaged most effectively by upright faces, with inverted faces engaging primarily feature-coding mechanisms. We show that opposite figural aftereffects can be induced simultaneously for upright and inverted faces, demonstrating that distinct neural populations code upright and inverted faces. This result also suggests that expert (upright) face-coding mechanisms can be selectively adapted. These aftereffects occur for judgments of face normality and face gender and are robust to changes in face size, ruling out adaptation of low-level, retinotopically organized coding mechanisms. Our results suggest a resolution of a paradox in the face recognition literature. Neuroimaging studies have found surprisingly little orientation selectivity in the fusiform face area (FFA) despite evidence that this region plays a role in expert face coding and that expert face-coding mechanisms are selectively engaged by upright faces. Our results, demonstrating orientation-contingent adaptation of face-coding mechanisms, suggest that the FFA's apparent lack of orientation selectivity may be an artifact of averaging across distinct populations within the FFA that respond to upright and inverted faces.

Adult↗

PubMed2006

Reliability of diagnoses coding with ICD-10.

OBJECTIVE: Reliability of diagnoses coding is essential for the use of routine data in a national health care system. The present investigation compares reliability of diagnoses coding with ICD-10 between three groups of coding subjects. METHOD: One hundred and eighteen students coded 15 diagnoses lists, 27 medical managers from hospitals 34 discharge letters, and 13 coding specialists 12 discharge letters. Agreement in principal diagnosis was assessed using Cohen's Kappa and the fraction of coincidences over the number of pairs, agreement for the full set of diagnoses with a previously developed measure p(om). RESULTS: Kappa values were fair (managers) or moderate (coders) for terminal codes with 0.27 and 0.42 (agreement 29.2% versus 46.8%), substantial for the chapter level with 0.71 and 0.72 (agreement 78.3% versus 80.8%). p(om) was lower for the full set of diagnoses than for principal diagnoses, for example in case of managers with 0.21 versus 0.29 for terminal codes. Best results were achieved by students coding diagnoses lists. In summary, the results are remarkably lower than in earlier publications. CONCLUSION: The refinement of the ICD-10 accompanied by innumerous coding rules has established a complex environment that leads to significant uncertainties even for experts. Use of coded data for quality management, health care financing, and health care policy requires a remarkable simplification of ICD-10 to receive a valid image of health care reality.

Diagnosis-Related Groups↗

PubMed2006

International classification of diseases and current procedural terminology codes underestimated thrombolytic use for ischemic stroke.

BACKGROUND AND OBJECTIVE: To determine the accuracy of recently introduced International Classification of Diseases Ninth Revision (ICD-9) procedure and Current Procedural Terminology (CPT) codes designed for injection or infusion of thrombolytic agents. MATERIALS AND METHODS: We determined the accuracy of ICD-9 procedure code 99.10 and CPT codes 37201, 37202 for use of thrombolysis in ischemic stroke by comparing procedure codes of University Hospital discharge data with a concurrent prospective registry. RESULTS: Of the 369 ischemic stroke patients, 49 (13.3%) received either intravenous and/or intraarterial thrombolysis. The sensitivity and specificity for ICD-9 procedure code 99.10 was 55% and 98% and CPT procedure code 37201 and 37202 was 49% and 99%. Identification by either ICD-9 codes or CPT codes yielded a high sensitivity and specificity of 82% and 98%. CONCLUSIONS: The use of ICD-9 and CPT codes alone may underestimate the use of thrombolytics using national and regional database. Best results are achieved when a combination of ICD-9 and CPT codes are used to identify the use of thrombolytics.

Brain Ischemia↗

PubMed2004

Computerized coding of injury narrative data from the National Health Interview Survey.

OBJECTIVE: To investigate the accuracy of a computerized method for classifying injury narratives into external-cause-of-injury and poisoning (E-code) categories. METHODS: This study used injury narratives and corresponding E-codes assigned by experts from the 1997 and 1998 US National Health Interview Survey (NHIS). A Fuzzy Bayesian model was used to assign injury descriptions to 13 E-code categories. Sensitivity, specificity and positive predictive value were measured by comparing the computer generated codes with E-code categories assigned by experts. RESULTS: The computer program correctly classified 4695 (82.7%) of the 5677 injury narratives when multiple words were included as keywords in the model. The use of multiple-word predictors compared with using single words alone improved both the sensitivity and specificity of the computer generated codes. The program is capable of identifying and filtering out cases that would benefit most from manual coding. For example, the program could be used to code the narrative if the maximum probability of a category given the keywords in the narrative was at least 0.9. If the maximum probability was lower than 0.9 (which will be the case for approximately 33% of the narratives) the case would be filtered out for manual review. CONCLUSIONS: A computer program based on Fuzzy Bayes logic is capable of accurately categorizing cause-of-injury codes from injury narratives. The capacity to filter out certain cases for manual coding improves the utility of this process.

Forms and Records Control↗

PubMedDate not supplied

Some thoughts about neural coding and spike trains.

This communication introduces the topic. Foundations: Core concepts: Codings are relations summarized by rules or 'codes'. Special codings are 'neural', 'natural' (in everyday life), 'experimental' (in laboratories), 'conditional' (to partner restrictions). etc. Partial aspects are mechanisms, what partners say about each other, etc. Critical experimental issues: Trains are evaluated by when spikes occur: i.e. as point processes and timings. Trains and point process representations become synonyms. Any code must: (i) be a 'number (rate) code' and an 'interval code'; and (ii) include 'referent, train' covariations involving steady states with overall averages and fluctuations with patterns (dispersions, sequences). Seminal findings. Early data proved trains participated in codings; this is accepted unanimously. Inevitably, though accepted less readily, codings included rates, intervals, averages and patterns. Literature highlights. (1) Confirmed the seminal finding (2.2.) over vast domains; (2) Demonstrated both general and synaptic codings (referents, respectively, sensory, states, etc. and trains in directly connected neurons); (3) Revealed overlap between general and synaptic coding features. Overlap allows train participation in network dynamics; (4) Introduced natural formal contexts. (Point Process Mathematics, Communication. Information and Dynamical Systems Theories); (5) Includes confused opinions: (i) Opposition between rates and intervals; (ii) claims that averages are meaningful but patterns irrelevant. Both, overlooking foundations and evidence, are untenable.

Action Potentials↗