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PubMed1982

Electrocutaneous code pairs for artificial sensory communication systems.

Pairs of electrocutaneous codes suitable for dual-channel sensory communication systems were compared using a dual-channel electrocutaneous tracking task. The tracking task required the test subject to dynamically respond to changes in the tactile sensation being modulated by two independent pseudorandom signals, one for each channel. The rule (or method) by which the signals changed the tactile sensations was called an electrocutaneous code. Four frequency variation codes and two intensity variation codes were paired in different combinations and then checked as to their effectiveness for sensory communications. The experimental protocol used a balanced incomplete block design which involved 24 subjects testing 3 of 8 code pairs each. Although the variance in the tracking performances between subjects was larger than the differences between the code pairs, learning rates for the various pairs were significantly different. The easiest one to learn was the Low Pulse Rate Modulation Code paired with itself. other findings included the general superiority of monophasic stimulation code pairs over biphasic stimulation code pairs, the need for placement of the two electrodes on different dermatomes in order to achieve satisfactory dual-channel communications, and the greater sensitivity to electrocutaneous stimulation of the ventral side of the forearm versus its dorsal side.

Biomedical Engineering↗

PubMed2001

An analysis of serial Minnesota ECG code changes in the London cohort of the WHO Multinational Study of Vascular Disease in Diabetes.

AIMS/HYPOTHESIS: Deterioration and improvement in the electrocardiogram are important outcomes in cardiovascular disease progression assessment. We used a sample of serial records from the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) to assess Minnesota coding variability. METHODS: A constructed subsample of 118 of the 352 paired (baseline and follow-up) and previously Minnesota-coded ECG records from the London cohort was randomised and re-read independently of the first code (respectively 11 and 0.5 years later) by the same two coders. Detailed Minnesota codes were summary coded into groups 1 (CHD unlikely), 2 and 3 (CHD possible and probable, respectively). RESULTS: Re-reading of the constructed sample for the baseline records (11 years later) generated 21 Summary code reassignments (2 unlikely to possible or probable; 19 possible or probable to unlikely); re-reading for the follow-up records (0.5 years later) generated only 8 summary code reassignments (21 vs 8p < 0.001) (3 unlikely to possible or probable; 4 possible or probable to unlikely; 1 probable to possible). Re-reading increased the estimated net ECG deterioration in the constructed sample from 11.8 % to 25.4%. Consistency analysis showed most variability in marginal baseline abnormalities. CONCLUSION/INTERPRETATION: Coding variability is now small though re-reading suggests some time-dependent coding drift. Relative over-reading at baseline suggests that the change reported in the complete WHO MSVDD cohort at follow-up was underestimated and that almost all of the reported ECG deterioration and about half of the reported ECG 'improvement' was real.

Cardiovascular Diseases↗

PubMed2004

[Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system].

INTRODUCTION: The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. PURPOSE: The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. METHODS: In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. RESULTS: Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. CONCLUSIONS: Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

Diagnosis-Related Groups↗

PubMed1995

A new drug classification for computer systems: the ATC extension code.

During the testing of the Read Clinical Codes in general practice medical records in Australia, it became apparent that the pharmaceutical section of the codes was not applicable in a country with different brand names, pack sizes and forms. For pharmacoepidemiological studies, structured classification of both morbidity and pharmaceuticals is required for meaningful analysis. The search for a suitable pharmaceutical classification proved fruitless. While the Australian Government has recently adopted the Anatomical Therapeutic Chemical (ATC) Classification as the national standard, this only classifies drugs to the generic level. None of the extended coding systems used in hospital pharmacies, by community pharmacists, or by Government are hierarchically structured. The extension code we have developed, is an analytical algorithm comprising independent fields for: dosage; strength; manufacturer and brand; and pack size. The codes within each field are also structured in a hierarchical manner. The result is an extension code of 21 digits, each digit or group of digits having a meaning. The structure of this classification will allow analysis of any aspect of the drug prescribed. This system is designed for computerised entry of text and transparent coding of the data--not for manual coding on paper nor manual code entry to the computer.

Algorithms↗

PubMed1993

Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network.

There is no gold standard for determining poisoning incidence. We wished to compare four measures of poisoning incidence: International Classification of Diseases 9th Revision (ICD-9) principal (N-code) and supplemental external cause of injury (E-code) designations, poison control center (PCC) reporting, and detection by the Drug Abuse Warning Network (DAWN). We studied a case series at two urban hospitals. We assigned ICD-9 N-code and E-code classifications, determining whether these matched with medical records. We ascertained PCC and DAWN system reporting. A total of 724 subjects met entry criteria; 533 were studied (74%). We matched poisoning N-codes for 278 patients (52%), E-code by cause in 306 patients (57%), and E-code by intent in 171 patients (32%). A total of 383 patients (72%) received any poisoning N-code or any E-code. We found that PCC and DAWN reporting occurred for 123 of all patients (23%) and 399 of 487 eligible patients (82%), respectively. In multiple logistic regression, factors of age, hospital admission, suicidal intent, principal poisoning or overdose type, and mixed drug overdose were statistically significant predictors of case match or report varying by surveillance measure. Our findings indicate that common surveillance measures of poisoning and drug overdose may systematically undercount morbidity.

Adolescent↗

PubMed2005

The new apheresis and blood and marrow transplantation-related current procedural terminology codes for payment of apheresis and blood and marrow transplantation services.

To address deficiencies in Current Procedural Terminology (CPT) codes that describe many of the clinical services offered to patients, several physicians in the blood and marrow transplantation and apheresis field joined with a coalition including the American Society of Hematology, American Society for Blood and Marrow Transplantation, American Association of Blood Banks, American Society of Clinical Oncology, American Society for Apheresis, National Marrow Donor Program, and American Red Cross to collaborate in addressing these deficiencies by designing new CPT codes. The CPT editorial panel approved 18 new or revised codes. All these codes were given permanent or temporary value by the relative value unit update committee, but not all values were approved by the Centers for Medicare & Medicaid Services (CMS), in particular, the cell-processing codes and the unrelated donor search code. Further discussions addressing these concerns are under way with the CMS. Use of these new codes allows apheresis and transplant centers to charge appropriately for these services. This will help transplant center contracts with CPT codes, with payers more specifically describing services offered to these patients. In turn, this will give better justification for payment. This may allow certain payments for services to increase and help transplant centers better allocate revenue from fixed global case rate payments. Details about the individual codes and their approval process are reviewed in this article.

Blood Component Removal↗

PubMed2005

Experience using MedDRA for global events coding in HIV clinical trials.

OBJECTIVES: To assess the feasibility of coding with MedDRA, the Medical Dictionary for Regulatory Activities, not only serious adverse events required for notification but also all other events usually reported in HIV clinical trials. To develop an approach for MedDRA implementation within an institutional research unit that contributes to an efficient, concise and reproducible event coding. To evaluate the impact of the maintenance and the versioning of this new medical terminology. METHODS: MedDRA versions 3.0 and 5.0 were used for coding hundreds of events reported through two HIV clinical trials. The implementation of MedDRA consisted in the setup of a training program, guidelines to clinical investigators, coding rules and medical validation process. MedDRA version 6.1 was applied to the coding made with the MedDRA version 5.0 in order to identify the assignments affected by the new version and to determine the impact of versioning. RESULTS: Coding with MedDRA all types of events in HIV clinical trials was feasible even though coders experienced some difficulties due mainly to the lack of precision in the investigator verbatim and the high specificity and sensitivity of MedDRA. The addition of appropriate tools to support the use of MedDRA improved significantly the coding of all types of events in HIV clinical trials. The impact of MedDRA versioning was limited and did not result in significant issues. The global implementation process of MedDRA required important resources in terms of qualified personnel, organisation and maintenance. CONCLUSIONS: Guidelines for investigators, coding rules and medical validation appeared to be mandatory for a successful implementation of MedDRA. The use of MedDRA, with the addition of the mentioned support tools, should ensure coding consistency and facilitate the clinical and tolerance analyses and meta-analyses in clinical trials.

Adverse Drug Reaction Reporting Systems↗

PubMed2004

ICD-9-CM codes poorly indentified venous thromboembolism during pregnancy.

OBJECTIVE: There is little data regarding the accuracy of pregnancy-specific ICD-9-CM codes used to identify patients with venous thromboembolism (VTE). STUDY DESIGN AND SETTING: We identified a large cohort of pregnant patients in whom there were one or more pregnancy-specific (600 codes) or standard ICD-9-CM codes (400 codes) for VTE. Charts of these cases were abstracted to determine the presence of objectively documented VTE. RESULTS: A total of 214 cases had a code for VTE either during pregnancy or the 6-week postpartum period; 82% had a pregnancy-specific code and 18% a standard code. Overall, 84 (39%, 95% CI=33-46%) had objectively documented VTE. A pregnancy-specific ICD-9-CM for VTE had a positive predictive value (PPV) of 54/174=31% (95% CI=24-38%), whereas standard VTE codes had a PPV of 30 of 38=80% (95% CI=63-99%). A PPV in the range of 95-100% could be attained using other criteria, at the expense of detecting only 28 to 45% of all VTE cases. CONCLUSIONS: Pregnancy-specific ICD-9-CM codes for VTE have low PPV. Other criteria must be applied to select cases with a high probability of having objectively documented VTE.

Adult↗

PubMed2002

Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands.

Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article focuses on the process and outcome of an urgency coding system in a fair selection of patients. It discusses the use of urgency codes in the daily practice of waiting list management and the related waiting times. Patients and their informal caregivers were followed from entry on the waiting list to admission to a nursing home. Caregivers were interviewed during the waiting period and after their relative's admission to a nursing home, and the formal urgency codes on the waiting list were monitored. Seventy-eight of the initial 93 patients were admitted to a nursing home. High urgency codes were commonly assigned and the waiting times were shorter for patients with higher urgency codes. Negative consequences of an urgency coding system, e.g. patients with less urgency not being admitted at all and patients not being admitted to the nursing home of their choice, could not be demonstrated. Patients without higher urgency codes were admitted after a mean waiting time of 28 weeks. It may be questioned whether this long waiting time is problematic, because satisfaction of the caregivers with regard to waiting times was not influenced by the actual waiting times. An urgency coding system enables health care professionals to react to changes in the situation of both patients and caregivers by adjusting urgency codes to influence the length of time until nursing home admission.

Aged↗

PubMed1993

Accuracy of bar codes versus handwriting for recording trauma resuscitation events.

STUDY OBJECTIVES: To compare the accuracy of computerized bar code data entry with conventional handwritten data entry during videotaped trauma resuscitations. SETTING: Laboratory; video simulation. TYPE OF PARTICIPANTS: Twenty-four emergency nurses. DESIGN: The nurses viewed videotapes of four different major trauma resuscitations during a single session. Each nurse recorded resuscitation events by handwritten entry in two cases and by bar code entry in another two. A computerized bar code system was designed specifically for contemporaneous charting of rapidly occurring events during trauma resuscitations. The handwritten and bar-coded records then were compared with a master list of events, and the number of entry errors were counted. Errors were defined as "omissions" (failing to record an event), "commissions" (recording an event that did not occur), or "inaccuracies" (errors in recording details of an event). ANALYSIS: Differences in the number of entry errors between the two recording methods were compared using unpaired t-tests. Differences in the number of errors after adjusting for the different nurses, different case being viewed, and order of viewing were analyzed using balanced analysis of variance techniques. P < .05 was considered significant. MAIN RESULTS: The mean +/- SEM number of total errors per record for bar codes was 2.63 +/- 0.24 compared with 4.48 +/- 0.30 for handwriting (P < .0001). The mean number of omissions per record for bar codes was 2.25 +/- 0.21 compared with 3.65 +/- 0.27 for handwriting (P = .0001). The mean number of inaccuracies per record for bar codes was 0.38 +/- 0.10 compared with 0.83 +/- 0.12 for handwriting (P = .0038). There were no commission-type errors. CONCLUSION: Computerized bar code data entry of trauma resuscitation events had significantly fewer entry errors than handwritten data entry in a laboratory setting. Potential advantages of bar code data entry include keyless data entry, automatic time-stamping, standardization of documentation, legibility of the medical record, and "point-of-care" data capture.

Electronic Data Processing↗

PubMed2003

Regional variation in medical classification agreement: benchmarking the coding gap.

The growing use of classification and coding of patient data in medical information systems has resulted in increased dependence on the accuracy of coding practices. Information maintained on systems must be trusted by both providers and managers in order to serve as a viable tool for the delivery of healthcare in an evidence-based environment. A national survey of health information managers was employed here to assess observed levels of coder agreement with physician code selections used in classifying patient data. Findings from this survey suggest that, on a national level, the quality of coded data may suffer as a result of disagreement or inconsistent coding within healthcare provider organizations, in an era where physicians are increasingly called upon to enter and classify patient data via computerized medical records. Nineteen percent of respondents report that coder-physician classification disagreement occurred on more than 5% of all patient encounters. In some cases disagreement occurs in 20% or more instances of code selection. This phenomenon occurred to varying degrees across regions and market areas, suggesting a confounding influence when coded data is aggregated for comparative purposes. In an evidence-based healthcare environment, coded data often serves as a representation of clinical performance. Given the increasing complexity of medical information classification systems, reliance on such data may pose a risk for both practitioners and managers without consistent agreement on coding practices and procedures.

Attitude of Health Personnel↗

PubMed1986

Activation of semantic and phonological codes during reading.

Three experiments used a new paradigm to examine word-coding processes during reading. Subjects read text passages and occasionally responded to lexical-decision probes. Experiment 1 focused on semantic and surface codes. The activation of semantic codes appeared to increase over time, whereas surface codes did not. In addition, subjects who were instructed to remember the exact wording of the passages showed stronger activation of surface codes than did subjects who read for comprehension. Experiments 2 and 3 explored the role of phonological codes. Experiment 2 showed that phonological codes were activated by specific words in a passage. In contrast, Experiment 3 found no evidence that phonological codes were activated by the more general passage context. Taken together, the experiments suggest some of the roles semantic and phonological codes may play during reading.

Cues↗

PubMed2000

Do we do what they say we do? coding errors in urology.

OBJECTIVE: To determine the accuracy of routine data coding in a large multispeciality urological unit. Materials and methods From the clinical records, the diagnosis and procedure codes were ascribed to 106 finished consultant episodes (FCEs) in urology, by two urological trainees. The codes were compared with those ascribed by professional hospital coders (and of which the trainees were unaware) from information written on the audit form by junior medical staff. Where there were discrepancies in codes an error was recorded and the stage in the coding process in which it occurred was determined. RESULTS: Forty-eight coding errors were found in 38 of the 106 (36%) FCEs; 34 (71%) were caused by inaccurate coding and 14 (29%) were the result of the incorrect completion of audit forms. CONCLUSION: The clinical codes generated from the authors' department do not accurately reflect the clinical practice. If coding errors of this magnitude are typical of urology units in general, the concept of hospital performance tables (which will be generated using routine clinical data) is untenable unless data recording is given higher priority.

Forms and Records Control↗

PubMed2001

[Extent and causes of coding problems for total compensation on the basis of Diagnosis-Related Groups].

UNLABELLED: BACKGROUND AND QUESTION: In contrast to the per-day-reimbursement specific data like diagnoses, procedures and demographic data of the patient is needed for a per case reimbursement with Diagnosis Related Groups (DRG). Coding errors can have great impact on the height of the reimbursement. A review of the extent and the causes of coding problems does not exist at present. METHODOLOGY: A systematic search in Medline using the search words >>coding<< and >>error<< and >>hospital<< was performed. Only articles with quantitative evaluation, written in English or German, were included. Literature cited in the articles was included as well. RESULTS: A total of 33 studies (53 113 cases) were identified. An average of 23 % of cases was showing coding problems. Eighteen percent of the cases were assigned to a wrong DRG. Regarding the date of publication no effect in the extent of the coding accuracy could be detected. CONCLUSION: An appreciable rate of cases with coding problems should be anticipated when introducing DRG. Training to improve coding accuracy is recommended. Whether coding should be a task of the ward or the management of the hospital could not be decided here, but it should be noted that this assignment of the coding task has major impact on the allocation of competence in the long run.

Diagnosis-Related Groups↗

PubMed2002

[Application of the new coding standards for introducing diagnosis related groups (DRGs) in ophthalmology].

For all in-patients a fundamental change of hospital financing based only on diagnosis related groups (DRGs) is planned in Germany for 2004. Patients are grouped into different DRGs according to their coded diagnoses, operations and procedures. Hence, the quality of coding is essential for adequate reimbursement of cases and thus for hospital financing. The legal framework of coding is supplied by the so-called "general and special coding guidelines for coding diseases and procedures", presented jointly by the associations representing hospitals and public and private health insurance companies in early 2002. These German coding standards regulate how coding must be performed in daily practice and therefore have a major influence on the grouping of patients into DRGs. Because of their importance this paper describes the practical application of current coding standards. Specifically in Ophthalmology the problem exists that for many procedures adequate coding numbers are still missing, thus impairing further development of the DRG system.

Diagnosis-Related Groups↗

PubMed2003

[Effects of contemporaneous control of DRG-relevant coding by physicians].

OBJECTIVE: In a prospective study we analysed the quality of ICD-coding in clinical everyday life of a department for internal medicine. METHODS: A skilled intern--the so-called DRG assistant--was temporarily released from clinical work. Over nine weeks he had to control all diagnoses contemporaneously that were ICD-coded by his colleagues on admission and discharge of their patients. The DRG-assistant had to ask for missing or correct implausible diagnoses, or inappropriate ICD-coding and with it also train his colleagues in appropriate coding. The effects of the DRG-assistant's correction of coding, on DRG-consistent grouping and on the potential financial loss or benefit generated by his work were recorded. After stoppage of this control in a subsequent phase of the study the effect of the absence of the DRG-assistant, the absence of reminders and coding control and the changes of the clinic's revenue were determined. RESULTS: Corrections of ICD-coding by the DRG-assistant alone caused a remarkable increase in case-mix-index (CMI). CMI's mean value increased from 1.76 to 1.84 and the clinic's revenue increased by 180 Euro per patient (a total of about 80,000 Euro in nine weeks). After the end of the control, the case-mix-index dropped within three weeks down to 1.14, corresponding with a potential loss of 1200 Euro per patient (assuming that patients' morbidity was the same over the time of the study). Coding corrections could not improve CMI in this situation. CONCLUSION: Contemporaneous control of ICD-coding by physicians seems to be essential in DRG based accounting.

Costs and Cost Analysis↗

PubMed1999

Formation of coding joints in V(D)J recombination-inducible severe combined immune deficient pre-B cell lines.

Characterization of the severe combined immune deficient (scid) defect in the recombination process has provided many insights into the underlying mechanisms of variable (diversity) joining recombination. By using recombination-inducible scid pre-B cell lines transformed with the temperature-sensitive Abelson-murine leukemia virus, we show that large quantities of recombination intermediates can be generated, and their resolution can be followed during further cell culture. In this study, we demonstrate that the ability of these scid pre-B cell lines to resolve coding ends depends on the cell culture temperature. At the nonpermissive temperature of 39 degreesC, scid pre-B cell lines fail to form coding joints and contain mostly unresolved hairpin-coding ends. Once the cell culture is returned to the permissive temperature of 33 degreesC, these same cells make a significant amount of coding joints concomitant with the disappearance of hairpin-coding ends. Thus, the scid cells are capable of resolving coding ends under certain culture conditions. However, the majority of the recovered coding joints contains extensive deletions, indicating that the temperature-dependent resolution of coding ends is still scid-like. Our results suggest that the inability of scid cells to promptly nick hairpin-coding ends may lead to aberrant joining in these cells.

Animals↗

PubMed1994

Eye movement behaviour viewing colour-coded and monochrome avionic displays.

This paper reports on two experiments in which subjects' eye movement behaviour was monitored while they searched for target information in colour coded and monochrome horizontal situation indicator (HSI) displays. The first experiment required subjects to locate and report alphanumeric information associated with the active waypoint on the displayed flightpath. Initial fixations in the display were more accurately directed to the target information when it was redundantly colour coded compared with when it was coded by shape and relative positional codes. Fewer fixations and a shorter time were required to locate the colour coded target and verbally report the relevant information. The time advantage of colour coded displays compared with monochrome displays was greatest for visually cluttered displays. In the second study there was no advantage of a coloured display when the task was to count all the displayed waypoint symbols on the flight path. The lack of any benefit for colour coding was a result of waypoint symbols having strong positional predictability due to their relationship to the displayed flightpath in both the colour and monochrome displays. The implication from these results is that colour coded information confers an advantage over a spatial code for targets at unknown spatial location but less benefit when target location can be predicted by other visual cues.

Aerospace Medicine↗