Volume 17. Codes relevant to creating Maternity or Neonatal Computer Systems
Co-Editors: Rupert Fawdry and Helga Perry
To see a sample page www.fawdry.info/eepd/17_pnt/Sample17.pdf
Discussion Links: None specific so far. Use www.eepd.org.uk
"In clinical medicine, codes must always be our servants,
never our masters!"
A. Discussion on the importance of NOT using such codes as the basis for “Individual Patient Care” "Question & All Answer Options" Computer Systems.
B. Efficient access to those ICD-9, ICD-10, OPCS, Read and SNOMED codes which are relevant to the creation of Perinatal Computer Systems.
C. Comments on the Relationship between such “Individual Patient Care” Q & As Computer Systems and Clinical Coding Clerks.
(Updated 3rd Aug 2010)
Introduction (Draft version only)
It will be noted that this volume comes way down at 17 in the order of EEPD priorities. This is intentional. The most important principle involved is that codes may (often automatically) be derived from “Priority to Individual Care” clinical computer systems with their set lists of Questions & all Allowable Answer Options.
It is, however, disastrously damaging to patient care and good communication if there is any attempt, as in some systems, to create “Priority to Individual Care” clinical systems where everything in the whole system must have a code.
a) most clinicians have no idea about what is involved in coding. They would almost all be horrified at the reality if they ever bothered to think seriously about codes. It appears from the welcome I get that I am one of the very few consultants who ever regularly visits coding departments.
b) existing coding systems are still far too often based on an obsolete paper-only mentality.
c) coding is mainly based on management and costing priorities. While management and costing is vital, it must not be given priority.
As a result of the above factors, we get nonsense combinations such as can be seen in www.fawdry.info/eepd/17_cod/Codes.pdf.
To have a code for “Elective Section - Lower Segment” is a silly mixture of “Urgency of Caesarean” and “Incision on Uterus”
The power of the computer should then be used to interrogate such computers and automatically work out which pregnancies were
Vomiting (before 22 weeks), Vomiting (after 22 weeks), Hyperemesis (before 22 weeks), vomiting (after 22 weeks)
We no longer need a separate code for
BB40 ZMb12 Stillbirth L2641 Intrauterine death-delivered
By starting with existing codes and then adding to them, code makers seem to have completely lost the plot.
Codes are only needed for later analysis and not, as is still too common, as the basis for “Individual Patient Care” computer systems. Indeed, it is my considered view that proper Qs & As clinical computer systems should totally ignore all traditional codes until after the whole hospital episode, whereupon only important codes should be automatically generated in a provisional format from specific answers to plain English questions.
I knew James Read personally, and even gave talks about how in future electronic records "buildings" would be made up only of Read Coding ‘Bricks.’ I later realised that the relationship between data items was just as important as codes, and, in any case, why use codes at all when computers were capable of coping with plain English IF THE WORDING IS STANDARDISED. I now view codes as very secondary; and have only included links to them on the EEPD so that those creating clinical computer systems can quickly look up which of the rather restricted set of codes might fit the complex Qs and As reality, e.g. if IPCS were still the standard code. I am convinced that the whole foundation of coding now needs to be totally re-assessed to take full account of the eventual universal use of “Personal Patient Care” standardised Qs & As computer systems.
Maybe ICD10 makes more sense but the existing ICD9/Read codes have options which are clinical nonsense such as
Elect lower segm caesar deliv,
Elective caesarean delivery NEC,
Lower segm caesar delivery NEC
Whereas proper Logical Priority Q & As system would have
1. Route of Birth?
WHEN ASKED. Always if Gestation > 20 weeks.
3. Other (free text)
2. Site of Uterine Incision?
WHEN ASKED. Only if “Route of Birth” = “Caesarean”
1 Lower Segment - Transverse
2. Lower Segment - Vertical
3. Upper Segment - Vertical
4. Other (free text)
3. Urgency of this Caesarean?
WHEN ASKED. Only if “Route of Birth” = “Caesarean”
1. Immediate (Crash Section): (Within 20 mins?)
ICD9: R182 Lower segm caesar delivery NEC
2. Urgent: (Within 30 mins?) ICD9: R182 Lower segm caesar delivery NEC
3. Scheduled: (Within 2 hrs?) ICD9: R182 Lower caesar delivery NEC
4. Planned (= Elective) ICD9: R172 Elective caesarean deliv NEC
5. Planned done as an Emergency ICD9: R182 Lower segm caesar delivery NEC
6. Peri-mortem (Caesarean at the time of a Maternal Death)
8. Other (free text
9. Unknown (free Text)
In time each relevant Answer in Volume 5 “Logical Priority” Questions should indicate any possibly relevant codes.
Updated RF & HP 3rd Oct 2010