Clinical coding internationally: A comparison of the coding workforce in Australia, America, Canada and England

Source: OAI

ABSTRACT Recently, researchers in Australia, America, England and Canada have conducted national surveys of clinical coders in their respective countries. In Australia in 2002, the National Centre for Classification in Health (NCCH) in collaboration with the Health Information Management Association of Australia and the Clinical Coders’ Society of Australia conducted the National Clinical Coder Workforce survey, a study of clinical coders and coding managers . In America in 2002, the American Health Information Management Association (AHIMA) commissioned an independent national workforce research study to the Centre for Health Workforce Studies (CHWS), State University of New York at Albany to provide a picture of health information management roles today and forecast through 2010 . In England in 2003, the National Health Service Information Authority (NHSIA) conducted a national clinical coder survey, along with a survey of coding managers, in a similar format to that completed by Australia . In Canada, in 2002, a study was conducted by the Canadian Health Record Association (CHRA) (currently known as the Canadian Health Information Management Association (CHIMA)) and Thiinc iMi, which provided information regarding the various roles health record professionals have in the healthcare sector, the qualifications of health record professionals and their salaries .

While these surveys have been conducted independently, they have addressed similar issues in terms of coders' salaries, educational backgrounds, roles and responsibilities, resources, experience, and continuing education needs. While several papers/reports have been generated from the individual research at a national level, there has been no systematic comparison of the coder workforce at an international level to date. This paper will describe the findings of each of the national surveys, and seeks to identify similarities and differences in important aspects of the coder workforce at an international level.

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    ABSTRACT: Background: Clinical coding is an integral part of health information management (HIM) practice which provides valuable data for healthcare quality evaluation, health resource allocation, health services research, medical billing, public health programming, Case-Mix/DRG funding. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) is a veritable tool for the effectiveness of clinical coding practices. Objective: This present study determined implementation levels of ICD-10 as well as ICD-10-PCS and clinical coding practices in both public and forprofit hospitals in Nigeria. Methods: We used Chi square (χ2) and Cramer’s V (φc) to assess the level of association between type of workplace and implementations of ICD-10 and clinical coding practices. Statistical significance was set at .05. Result: The study discovered nationwide implementation of ICD-10 (179, 88.2%) and fair adoption of its procedure counterpart (79, 38.9%). Most hospitals in Nigeria especially, for-profit facilities (3, 100%) and tertiary healthcare settings (148, 93.1%) employed HIM professionals (214, 91.5%) to manage their clinical coding processes. Conversely, the study observed that challenges confronting clinical coding processes were enormous. Notable among these were absence of automation (70, 34.5%), lack of political will (51, 48.1%), inadequate clinical coders (153, 74.4%) and suboptimal documentation (186, 91.6). Suggestions to improve clinical coding practices ranges from continuing professional coding education (33, 10.3%) to initiation of Nigerian’s modification of ICD such that ICD-10 will become ICD-10-NGM (1, 0.3%). Conclusion: Most healthcare systems in Nigeria have implemented ICD-10 for coding and classification of diagnoses and procedures and the process is being managed by the right workforce (i.e. HIM professionals) which reassures effectiveness. However, lack of political will, inadequate and unmotivated workforce and suboptimal clinical documentation were among challenges confronting the practice in Nigeria. Therefore, this study suggests advocacy and coding education with a view to modifying the orientation of all stakeholders and to sensitize relevant authorities on the benefits of clinical coding practices in order to maximize its outcome and in effect, improve public health in the country. Keywords: Automated Coding, Clinical Coding, Clinical Documentation, Data Quality, Discharge Summary, Health Information Technology, Health Information Management Professionals, ICD-10
    American Journal of Health Research. 12/2014; 3(1-1):38-46.

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May 31, 2014