Aspects of coding in Canada: through the eyes of an Australian HIM.
Abstract: 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.

Keywords (MeSH): International Classification of Diseases; ICD-10-CA; Training Programs; Canada.
Article Type: Report
Subject: Diseases (Canada)
Diseases (Identification and classification)
Practice guidelines (Medicine) (Evaluation)
Medical protocols (Evaluation)
Author: Bidie, Alison
Pub Date: 02/01/2009
Publication: Name: Health Information Management Journal Publisher: Health Information Management Association of Australia Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Health Information Management Association of Australia Ltd. ISSN: 1833-3583
Issue: Date: Feb, 2009 Source Volume: 38 Source Issue: 1
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 216488648
Full Text: Classification changes

Since 2001, coders in Canada have been busy adapting to a new national classification system known as ICD-10-CA and CCI. ICD-10-CA is the enhanced Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. It replaced the earlier ICD-9/ICD-9-CM classification. CCI refers to the Canadian Classification of Health Interventions, developed to accompany ICD-10-CA.

The staggered implementation across ten provinces and three territories was completed by 2007 and enabled improved comparability of morbidity data across the country.

Training opportunities

Coders play a significant role in the Canadian health care sector. They are generally graduates from a recognised health information management program and work in various health care settings. In the workforce, coders have continuous opportunities for training and professional development from the Canadian Institute for Health Information (CIHI) as well as the Canadian Health Information Management Association (CHIMA). CIHI is a national, not-for-profit organisation responsible for collecting data on healthcare services, health spending, population health, and for producing in-depth analytical and summary reports on the health of Canadians and the healthcare system. CIHI is also responsible for the development and maintenance of ICD10-CA/ CCI and the Canadian Coding Standards to promote data quality and consistency in coding. CIHI's website is CHIMA is the national association for health information management professionals. Additional information is available at the website

No coding books required!

ICD-10-CA/CCI is produced as an electronic coding book, or 'infobase'. This innovation has removed the need for heavy coding books and is a change welcomed by coders. Additionally, coding standards and abstracting manuals are available as PDF files for easier access at workstations.

CIHI produces a range of coding resources to support coders. This includes face-to-face workshops and e-learning products that address coding standards and abstracting guidelines. All coding resources are developed in English and French to serve clients across Canada. Coders may also utilise CIHI's online coding query database to search for related coding topics or submit new ICD-10-CA/ CCI coding questions. Responses are sent directly to the requesting client and generally posted as reference for other coders.

Coding and abstracting

Coders at acute care hospitals are generally specialists in coding inpatient, day surgery and/ or emergency data, which are then submitted to CIHI. CIHI currently has 24 data holdings which collect clinical, administrative and financial data from across Canada. The Discharge Abstract Database (DAD) captures national inpatient data while emergency and outpatient clinic visits are submitted by some provinces to the National Ambulatory Care Reporting System (NACRS). Coding standards and abstracting guidelines are updated annually, requiring coders to remain current with any modifications.

Coding studies

Coding studies are often referred to as 'reabstraction' studies in which trained auditors independently recode selected inpatient discharges or ambulatory care visits at a hospital. 'Re'abstracted information is then compared to the originally abstracted data and potential sources of the coding variation are identified. Coding auditors are known as 'reabstractors'.

Various studies have been undertaken to assess coding quality and identify areas for improvement. In recent provincial and national studies, CIHI has recruited and trained coders to participate as reabstractors (coding auditors). This is an exciting and unique opportunity for health information management professionals across Canada. Candidates are invited to attend a one-week training session to learn specific reabstraction (auditing) concepts and obtain a refresher on coding standards. This is followed by a coding test, which determines the final coders who will participate in data collection.

Reabstractors who have participated in past CIHI studies have gained tremendous insight from their 'adventures' in hospitals across the country. These positive experiences have led many to reapply to take part in subsequent coding studies.

In conclusion

HIM professionals will continue to make significant contributions to the Canadian health care sector. Web-based resources are expanding to meet the educational needs of coders across this vast country. Similar to their Australian colleagues, Canadian coders strive to remain up to date on classifications and coding standards, and are open to new learning opportunities.

Alison Bidie BMedRecAdmin, GradDipApplInfoSyst

Program Consultant, Data Quality

Canadian Institute for Health Information

4110 Yonge Street, Suite 300, Toronto ON M2P 2B7



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