Health Finance and Governance Activity Coding Discussion Paper

The two main codes for health care are diagnosis codes, which identify the reason for treatment, and procedure codes, which specify the treatment provided. If these codes are not standardized at a country level, it will be difficult to measure trends and identify areas for improvement. In Jordan, the current coding systems in use are primarily based on the International Classification of Diseases, 9th Revision (ICD-9) for diagnosis codes and a unique set of procedure codes for each hospital. However, the use of ICD-9 is considered outdated, and there is a need for a standardized procedure coding classification system. The Electronic Health Systems (EHS)/Hakeem organization has mapped individual Jordanian hospital procedure codes into the Electronic Medical Record (EMR), resulting in hospitals having a unique set of codes that are not applicable across the public hospitals, making it difficult to have any type of comparison. The cost of licensing the US Current Procedural Terminology (CPT) codes is too high, but there is a way to manage this, similar to the UAE, which is using an older version of CPT for a 50% discount, which is also available to Jordan. The World Health Organization (WHO) ICD-10 diagnosis coding set is widely accepted in Jordan and most of the private hospitals have updated to ICD-10. Based on the Jordanian context and discussions with coding experts, five procedure code sets are recommended: National codes presented by Royal Medical Services (RMS), MBS (core Australian code set), Full Australian Classification of Health Interventions (ACHI - full Australian code set), Current Procedural Terminology (CPT - US), and International Classification of Health Interventions (ICHI - WHO). The selection of a coding system includes not only which code sets to use but also the related billing guidelines, coding training, and formal coding audits to assure accuracy and prevent fraud and abuse. Introducing coding without training and audits is not recommended. The stakeholders' meeting discussed the objectives of a standard coding system and ranked the available classification systems based on use. The top goals of a coding system in Jordan are improving clinical delivery, supporting the Electronic Medical Record (EMR), providing data to estimate cost, and being a long-term coding system. The US CPT received the highest ranking, followed by the Australian ACHI codes. The implementation of a standardized coding system in Jordan involves several phases. Phase 1 is infrastructure development, which includes setting up the necessary infrastructure to support the new coding system. Phase 2 is training and support tool development, which involves providing training to healthcare professionals and developing support tools to help them use the new coding system. Phase 3 is real-time implementation, which involves implementing the new coding system in real-time. Phase 4 is evaluation and refinement, which involves evaluating the effectiveness of the new coding system and making any necessary refinements. The stakeholders' meeting also discussed the importance of standard coding and its role in enabling effective health financing and risk management programming. Standard diagnosis and procedure coding is essential at a country level, and standard code sets accepted at a country level are required to enable effective health financing and risk management programming. The meeting also discussed the challenges of implementing electronic documentation without standardized language (coding) and the importance of considering the costs associated with the selected coding system, including administrative and associated human resources costs.