CLINICAL CODING FOR BM

1
CLINICAL CODING FOR BM PBSC TRANSPLANT
PROCEDURES

• Dr Kim Orchard Transplant Director
• Carol Hurlock Data Manager
• Wessex Blood and Marrow Transplantation Service

2
Introduction

• Discrepancy between WBMTU activity as returned to
  EBMT and local Patient Administration System
  (PAS) coding errors

• Not just an internal issue of coding
• Central South Coast Specialist Services
• Commissioners report on our BMTs
• - accessing PAS only

3
Introduction
What they thought we did vs what we actually did
4
Introduction

• Concerns raised with the BSBMT

• How widespread was this problem?
• - survey of coding practice in transplant centres

5
Aim

• To determine whether transplant procedure coding
  is consistent across the UK
• To establish the codes currently used by UK
  transplant centres
• To raise awareness of the importance of clinical
  coding for transplant procedures
• To present the findings to the BSBMT Executive
  Committee

6
Plan

• Design two questionnaires
• One to be completed by the transplant clinician
• One to be completed by the clinical coding
  department within the transplant centre
• Questionnaires sent and responses collected by
  Keiren Towlson on behalf of the BSBMT

7
Process

• Both questionnaires sent 27th April 2006 to 56
  teams in 53 UK transplant centres

• Analyse responses received by 20th Nov 2006
• (following 1 reminder)

• Total of 16 clinician questionnaire
• responses received

• Total of 18 clinical coding department
• questionnaire responses received

8
Results Clinician Questionnaire
9
Results Coding Dept. Questionnaire
10
Results Coding Dept. Questionnaire
11
Results OPCS v4.3 Codes Used
BM Harvest

• 11 of 14 use Y667 Harvest of BM

- 9 centres use 2 codes (incl. Y667) to
reflect the harvest procedure undertaken -
5 centres use the same 2 codes

• 1 centre use 3 codes
• adding 1st stage of staged operation

- 1 centre use only Y667

• 3 centres use only 1 code which did not
• reflect a harvest procedure

12
Results BM Harvest

• X327 Leucopheresis
• W358 Introduction bone substance puncture bone
  therapeutic ( other specified)
• W341 Graft of BM Auto of BM nec

13
Results PBSC Harvest

• 14 of 16 use harvest codes

- 12 centres use Harvest of other tissue
- 2 centres use BM harvest

• 1 centre use Leucopheresis only
• (same centre as for BM harvest)

• 1 centre use Blood donation

• N.B. There is no specific PBSC harvest code

14
Results PBSC Harvest

• 8 of 14 centres use the same 3 codes to
• reflect PBSC harvest procedure

• - Y361 Blood donation
• - Y698 Harvest of other tissue
• - Y703 First stage of staged operation

15
Results Donor Harvest

• 9 of 11 centres use donation and / or harvest
  codes for BM and PBSC harvest procedures

• 1 centre uses X327 Leucopheresis
• for BM and PBSC (same centre as before)

• 1 centre use W341 Graft of BM - Auto of BM for
  BM and PBSC (same
  centre as before)

16
Results Autologous BM Transplant

• 13 of 14 centres use W341 Graft of BM Auto of
• BM nec to reflect autologous BM transplant
• procedure

• 1 centre use X338 Other blood transfusion
• other specified

• 2 centres added Y711 2nd stage of staged
  operations

17
Results Autologous PBSC Transplant

• 10 of 16 use X338 Other blood transfusion
  other
• spec and Y711 2nd stage of staged operations

• 1 centre use code X338 only

• 5 centres use W341 Graft of BM Auto BM nec

• N.B. There is no specific autologous PBSC
  transplant code

18
Results Allogeneic BM Transplant

• 10 of 11 centres use W34. codes specific to BM
  allograft transplant procedures

• 1 centre use X468 Donation of other tissue

19
Results Allogeneic PBSC Transplant

• 5 of 11 centres use X338 Other blood
  transfusion

• 5 centres use W34. codes specific to BM
  allograft
• transplant procedures

• 1 centre use X468 as for BM

N.B. There is no specific code for PBSC
Allogeneic transplant
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Summary - 1

• Clinician and clinical coding department
• response about their contact with each
• other did not correlate

• Less than half of the centres who
• responded validate their EBMT activity
• data against their PAS

• Coding transplant complications in 16 of 18
  centres. However, access to case notes occurred
  in only 14 centres!

21
Conclusions - 3
Summary - 2

• 2 centres reported codes for harvest and donor
• harvest that do not reflect these procedures

• 1 centre reported coding BM and PBSC
• autologous transplant as a blood transfusion

• 1 centre reported coding BM and PBSC
• allogeneic transplant as donation of other
  tissue

22
Conclusions - 4
Conclusions

• BM autologous and allogeneic transplant coding
  is the
• most accurate.
• - This is probably due to the fact that there
  are
• specific OPCS codes available

• Accuracy of clinical coding for bone marrow and
  
• peripheral stem cell transplant procedures is
  vital for
• both costing and quality purposes especially
  in a
• payment by results system

• There is a need for specific national guidance
  and new
• OPCS codes to accurately reflect PBSC
  transplant
• procedures

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Recommendations

• BSBMT to request all UK transplant
• centres validate their transplant activity
• prior to submission to the EBMT Registry
• against PAS

• Allocating specific personnel in coding
• would improve the consistency of
• coding for transplant procedures

24
New Release OPCS v4.4
X33.4 Autologous peripheral blood stem cell
transplant
X33.5 Syngeneic peripheral blood stem cell
transplant
X33.6 Allogeneic peripheral blood stem cell
transplant
W99 Graft of cord blood stem cells to BM

W99.1 Allograft of cord blood stem cells to BM