HIMagine That: Coding in Canada

Donna: Eh Sue. What did you think of our experience in Canada reviewing charts for accurate coding?

Sue: I would say that they have a similar challenge to ours in determining the first listed diagnosis for an inpatient stay. We call it a principal diagnosis here and in Canada they call it the most responsible diagnosis.

Donna: It must be a different thought process because the most responsible diagnosis was the condition identified as requiring the most care during the stay and did not have to be present on admission.

Sue: True. The other difference I noted was the reporting of secondary diagnoses. For example, they do not need to report chronic conditions even if they continue to receive medication for them during the inpatient stay. If secondary diagnoses do not meet the Canadian criteria for significance reporting them is optional.

Donna: I found it significant that Australia follows the same guideline and both countries have been on ICD-10 for quite some time.

Sue: The one frustrating part of the coding adventure in Canada for me was not being able to turn off the rules and regulations that I am used to following in the United States. I kept wanting to identify all conditions pertinent to the patient, including chronic conditions!

Donna: Remember, we could identify those secondary diagnoses that were treated or evaluated during the stay, which they called significance criteria. So, if a chronic condition was re-evaluated in a consultation or labs indicated a need for a dosage change, then the diagnosis could be coded.

Sue: I think we drove the Canadian coding professionals a little crazy by asking questions like “Can we code this condition?” or “We report this in the United States, how do you report it?”

Donna: It was interesting that the coding focused on reporting the social needs of the patient, like palliative services, convalescence or waiting for facility placement.

Sue: Diagnoses were identified as the one main condition, pre-morbid conditions and post-morbid conditions which were identified with the number 1 or 2, respectively. The number 3 was used to identify other conditions similar to our secondary diagnoses but these were optional in most cases. It reminded me of our POA flags in a way.

Donna: The best part of our collaboration with the Canadian team was the camaraderie that came from sharing our experiences.

Sue: Even though we don’t code the same way, the coder experience seems universal, as the coders still had to interpret the physician documentation and decide what to code.

Donna: It certainly was enjoyable to discuss different scenarios with them to assist us in determining the correct coding.

Sue: They also talked about transitioning to ICD-11 which is supposed to be available next year. However, they won’t start using it until 2023.

Donna: You know what they say, “The more things change, the more they stay the same.”

Sue Belley, RHIA, Donna Smith, RHIA, are with the consulting services business of 3M Health Information Systems.