Thursday, 19 July 2012

Medical Codes Inadequate for Aspergillosis

Such is the importance of defining and controlling the cost of medical treatment we have had to find a way to classify many aspects of our health services into fixed codes. Specific costs can be attached to each code and thus any particular condition can be charged accurately - be it to a private insurer or to a public funded health service.
There are of course other reasons for accurate coding. We can quickly and efficiently gather statistics for each type of diagnosis and treatment and thus quickly get an understanding of prevalence in any country or throughout the parts of the world that use the same coding system. Funding can then be given proportionatly according to demand, demands on funding can be predicted on a national basis and funding allocated after debate - be that on a local or national basis.

Accurate coding can thus make a large contribution to the amount of funding given to a condition - in fact the funding can depend on the coding so if coding is inaccurate or unrepresentative it can have a severe effect on the money available to treat a particular condition - perhaps even the efficacy of the treatment itself especially for conditions where the cost of the drugs used to treat is high.

The value of accurate, consistent coding crossed  national boundaries as they enable like to be compared to like between countries, so there is extensive effort expended to provide clear codes for use by all countries and these are maintained by the World Health Organisation (WHO) in a set of codes referred to as International Classification of Diseases (ICD).
Aspergillosis is a disease that often requires highly expensive drugs to treat. Drug costs can run into several tens of thousands for pounds per year per person, so it is vital that coding is clear, comprehensive and accurate. Unfortunately this does not seem to be the case as yet. A search of ICD codes for aspergillosis reveals a small set of codes:

B44 Aspergillosis
    Incl.: aspergilloma
  • B44.0 Invasive pulmonary aspergillosis
  • B44.1 Other pulmonary aspergillosis
  • B44.2 Tonsillar aspergillosis
  • B44.7 Disseminated aspergillosis
Incl.: Generalized aspergillosis
  • B44.8 Other forms of aspergillosis
  • B44.9 Aspergillosis, unspecified
These codes are neither comprehensive, clear or particularly logical as e.g. Tonsillar aspergillosis is highly unusual and only recently described whereas infection of the sinus' is presumably lumped into the 'other forms' category and is far more common. There is no sign of ABPA. Likewise in the listing for asthma there is no sign of Severe Asthma with Fungal Sensitivity (SAFS) - both of the latter 2 categories are thought to be groups containing tens of thousands of cases.

A significant amount of work is needed to rewrite and reorganise this listing, otherwise these important groups of Aspergillus diseases will be poorly recorded and poorly funded as a consequence.

1 comment:

ajani abu said...

Certified Medical Coders do codes for Aspergillosis with the ICD-9 coding 117.3. The medical codes are referred to as the referred to as International Classification of Diseases (ICD).

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