Australian Coding Benchmark Audit

The National Centre for Classification in Health (NCCH) originally developed the Australian Coding Benchmark Audit (ACBA) in the early 2000s as a tool to be used to audit the quality of clinical coding in Australian health care facilities. ACBA principles are still used today in many health care facilities to undertake clinical coding audits. NCCH is currently looking into updating the tool to suit the current environment where quality coded data is vital for a number of purposes including the measurement of the quality of patient care and safety, research, health care planning and management and funding.

ACBA is based on the philosophy of continuous quality improvement (CQI). All coding quality activities should aim to provide an educational focus to clinical coders and clinicians to improve management of clinical coding services and healthcare facilities. Results of coding quality activities should be fed back to the clinical coders and clinicians in the spirit of CQI. Improvements in results can be made by addressing individual or system problems.

The ACBA is designed for use by all types of healthcare facilities. The ACBA is intended to be simple and aims to distinguish between ‘coder’ and ‘system’ errors. The ACBA methodology is suitable for use by clinical coders who have had little previous experience with coding quality studies.

It is essential that any tool used to measure the quality of ICD coding should distinguish problems made by the clinical coder from problems inherent in the coding process (or ‘system’ problems). CQI methods are used to study a process as a whole system and can be applied to the clinical coding process. The whole system of clinical coding audit includes:

  • measuring the accuracy of the codes being selected
  • feedback of results to the clinical coding staff identifying the reasons for variation, and implementing systems to prevent those situations from recurring.

The classification of clinical concepts and/or entities (i.e. a disease, complication or injury) into code is a complex activity. Because coded data are used in so many areas, it is essential that classification is performed correctly and consistently in order to produce meaningful statistics to aid in the planning of health care services.

In order to classify accurately, it is essential to have a working knowledge of medical science and to understand the characteristics, terminology and conventions of ICD-10-AM. The ICD-10-AM Alphabetic Index contains many terms not included in the ICD-10-AM Tabular List, and clinical classification requires that the Alphabetic Index, the Tabular List and the Australian Coding Standards are all consulted before a code is assigned.

Documentation within the current episode of admitted care is the primary source of information for the classification of inpatient morbidity data. Accurate classification is possible only after access to consistent and complete clinical information. Without good documentation, classification guidelines are difficult, if not impossible, to apply.
Although the goal of error-free coded data is probably unrealistic, it is essential to know the level of imperfection. ACBA can therefore assist in determining the underlying issues related to coding problems which can inform feedback and education strategies within the health care facility to improve both ‘system’ and/or ‘coding’ errors.