Abstract
We classify many things in our lives in order to make sense of them and to make them useful to us. In fact without this instinct to categorise the things with which we deal on a daily basis, we would find life very difficult. Supermarket shopping and searching for books on the library shelf, for example, would be difficult tasks indeed. In the work place, Health Information Managers (HIMs) and Clinical Coders make daily use of very specific classifications: the Australian modification of the International Classification of Diseases, ICD-10-AM, and the Australian Classification of Health Interventions (ACHI). These classifications are used by HIMs and Clinical Coders to assign codes for diseases and procedures respectively to the medical records of admitted patients. They in turn are used to derive AR-DRGs, another classification with which we are required to be very familiar. There are several other classifications that are used in the hospitals and health services that are less well known but with which those who work in specialist areas have become familiar, and yet other less formal classifications that have become essential knowledge for HIMs and Clinical Coders working in certain areas.

Abstract
The objective of this research was to examine the level of agreement of coders for ICD-10 coding of injury discharges in Danang General Hospital in Vietnam. Two hundred and five medical records of children hospitalised in this facility due to injury were randomly selected and recoded. Information from medical records abstracted by two trained staff was recoded by external coders in Hanoi and in Australia, using ICD-10. The completeness and detail of external cause of injury recorded in medical records was poor. Agreement between coders for injury coding was average, with 32% to 40% discrepancy in the main diagnosis codes at three character level, and 57% to 60% discrepancy at four character level, depending on which coders were being compared. It was concluded that as hospital data represent a cost-effective source of information regarding injuries, with significant costs incurred in collecting such information through special studies and censuses (especially for a developing country such as Vietnam), it is important to establish the quality and value of hospital data for injury surveillance and prevention research and to explore ways in which these data can be improved.

Abstract
As coded clinical data are used in a variety of areas (e.g. health services funding, epidemiology, health sciences research), coding errors have the potential to produce far-reaching consequences. In this study the causes and consequences of miscoding were reviewed. In particular, the impact of miscoding due to inadequate medical documentation on hospital funding was examined. Appropriate reimbursement of hospital revenue in the casemix-based (output-based) funding system in the state of Victoria, Australia relies upon accurate, comprehensive, and timely clinical coding. In order to assess the reliability of these data in a Melbourne tertiary hospital, this study aimed to: (a) measure discrepancies in clinical code assignment; (b) identify resultant Diagnosis Related Group (DRG) changes; (c) identify revenue shifts associated with the DRG changes; (d) identify the underlying causes of coding error and DRG change; and (e) recommend strategies to address the aforementioned. An internal audit was conducted on 752 surgical inpatient discharges from the hospital within a six-month period. In a blind audit, each episode was re-coded. Comparisons were made between the original codes and the auditor-assigned codes, and coding errors were grouped and statistically analysed by categories. Changes in DRGs and weighted inlier-equivalent separations (WIES) were compared and analysed, and underlying factors were identified. Approximately 16% of the 752 cases audited reflected a DRG change, equating to a significant revenue increase of nearly AU$575,300. Fifty-six percent of DRG change cases were due to documentation issues. Incorrect selection or coding of the principal diagnosis accounted for a further 13% of the DRG changes, and missing additional diagnosis codes for 29%. The most significant of the factors underlying coding error and DRG change was poor quality of documentation. It was concluded that the auditing process plays a critical role in the identification of causes of coding inaccuracy and, thence, in the improvement of coding accuracy in routine disease and procedure classification and in securing proper financial reimbursement.

Summary
In Australia, the National Centre for Classification in Health (NCCH) is ultimately responsible for updating ICD-10-AM disease codes and Australian Classification of Health Interventions (ACHI) procedure codes, and the accompanying Australian Coding Standards (ACS). New editions of these publications are released every two years. This article outlines the updating procedure and lists the sources of information upon which the NCCH draws when compiling data for new coding manuals.

Summary
Collections of routine, or ‘administrative’, hospital data have many applications in health care and are now recognised as valuable sources of information. In recent decades, administrative data have been seen primarily as funding and billing tools to assist with the reimbursement of hospitals for services provided; this purpose remains the primary focus of the clinical coder workforce. More recently, hospital data have been recognised as valuable resources for a range of health system improvement processes beyond funding. The focus of this paper is to review and demonstrate the diverse uses of administrative data in health services research and quality improvement. By gaining an understanding of how the data are used, we can appreciate the importance of good quality data from the perspective of its multiple uses. This paper describes a sample of the studies conducted in Australia using administrative data in health care improvement.

Summary
This article briefly relates the experience of a clinical coder working in the private healthcare sector in the Australian state of New South Wales and questions whether it is possible to work in this environment while adhering to the Clinical Coders’ Creed. Private facilities in Australia that handle acute, psychiatric, respite and rehabilitation cases, rely mainly upon health insurance funds for reimbursement for episodes of care, which are funded according to DRGs based on codes assigned by clinical coders. The point is made that while all coders strive to fully and accurately describe the clinical episode of care regardless of healthcare setting, a distinction can be drawn between public and private sector coding in relation to financial contracts, which form the basis of private health care. Therefore, it is recommended that private sector coders familiarise themselves with this “C” as well as the other seven “Cs” of the Clinical Coders’ Creed.

Summary
For the purpose of this brief update report, the author (an Australian Health Information Manager currently working in Canada) was asked to select certain aspects of the current coding system in Canada that she believes highlight relevant differences between the Canadian and Australian systems, on the assumption that this might be of interest to other Australian HIMs. The author has provided a brief overview of some recent changes to the Canadian classification system (e.g. new electronic product replacing coding books), as well a focus on some aspects of coder training and coding studies as seen through the eyes of an Australian HIM.

© 2009 Health Information Management Association of Australia Limited