ICD10 Implementation:Lessons from SA’s experienceRajesh PatelSeptember 2014Windhoek, Namibia

Objectives

• What is health governance?• Need for language standardisation• SA background to implementation• NAMAF or ?: Coding in Namibia• Implementation needs• International developments• Q&A

Stakeholders

Government/funders• Health governance

Service providers• Health governance• Medical audit

Coding relevant for all stakeholders!

Health governance

1. Health needs2. Health services or benefits3. Actions, interventions, programs4. M&E

• Medical Scheme:• Vehicle for the collection of funds to provide for the health

needs of “private” members

Dx Prevalence SA (%): Use of coding

Disease 2010 2011

Asthma 2.8 3.1

Diabetes 2.8 3.1

Hypertension 9.9 10.6

HIV (CMS) 1

Need for language standardization!

• ICD or ICPC• ICD10 or ICD11 or other

• Which one? • Choose and make the move!

Why Is Diagnostic Coding Important?

• used in the health care industry to classify and organize groups of diseases, disorders and symptoms.

• intended to improve both the response time and the accuracy of medical organizations.

• it improves the services that are available to the average person, and also makes them more manageable from an organizational perspective.

• is an information conduit, facilitating communication between different agencies and health care professionals.

Background

• Managed care introduction in SA 1995• Need for clinical information to be captured• Establishment of PHISC from RAMS/BHF

offices• ICD10• ICPC• ICD9CM

• 1997: DG announced adoption of ICD10• No documented record

Background

• MSA & Regulations 1999• PMB• Minimum data on claims, incl. diagnostic code

• PMBs from 2000• NHA of 2003 chapter 9• Need for coding to access PMB benefit

• ICD10 implementation for private sector billing from June 2005. Implementation TT co-ordinated by CMS

• 2011: Role of coding in NHI• 2012 Ministerial implementation task team

Implementation in Namibia

• Do you have regulatory support/enabling legislation?• Yes!• No!

• Voluntary implementation• Start with funder coding for managed care activities• Lots of documentation from SA

» www.health.gov.za

NAMAF or ? co-ordination

• Emphasis on coding training• Accredited coders• Coding trainers• Train the trainer programs• Staff coding training• Provider coding training

NAMAF or ? co-ordination

• Technical team: ICD10 Implementation Task Team• Coding expertise• Business process

expertise• IT system expertise• Clinicians with HIS

expertise• Governm. officials

NAMAF or ? co-ordination

• Standardisation of rules, use and systems to capture and communicate data

• Quality of coding• Confidentiality concerns

• Legitimate• Purpose of coding• Excuse for not co-operating

• Call centre

Grouper

• ACG: Johns Hopkins• DRG: various

International developments

• WHO: Family of coding classification• Diagnostic• Procedure• Disability

• MRC in SA: collaborating center• ICD10 rollout in US current• Development of ICD11

Thank You