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Classifications in routine use: lessons from ICD-9 and ICPM in surgical practice
J Stausberg1, H Lang, U Obertacke
1University of Essen, Essen, Germany. stausberg@uni-essen.de
Journal of the American Medical Informatics Association : JAMIA
|January 6, 2001
Summary
Current surgical coding systems like ICD-9 and OPS-301 inadequately reflect patient morbidity and surgical workload due to uneven granularity. A more precise terminology is needed for accurate surgical department quality assessment.
Area of Science:
- Medical Informatics
- Health Services Research
- Surgical Quality Assessment
Background:
- Accurate classification of diagnoses and procedures is crucial for evaluating surgical department economics and quality.
- Existing systems should reflect patient morbidity and the complexity of surgical work performed.
Purpose of the Study:
- To assess the suitability of ICD-9 (International Classification of Diseases, 9th Revision) and OPS-301 for reflecting surgical department morbidity and workload.
- To determine if current classifications meet the requirements for quality assessment in surgical practice.
Main Methods:
- A retrospective analysis of 28,293 operations from general surgery, neurosurgery, and trauma surgery departments.
- Evaluation of code distribution, aggregation, and concordance using ICD-9 and OPS-301.
- Utilized Lorenz curves to visualize case concentration per code.
Main Results:
- A low percentage of codes (up to 14%) were used across surgical fields.
- High concentration of cases: 10% of codes covered approximately 70% of procedures.
- OPS-301 showed better code distribution after aggregation compared to ICD-9.
Conclusions:
- Neither ICD-9 nor OPS-301 adequately represent surgical department morbidity or staff workload due to classification granularity.
- A replacement for ICD-9 with an improved surgical terminology system is recommended.
- OPS-301 is considered suitable for medium-term use in surgical coding.