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implementation_of_cluster_coding_fact_sheet

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smagi2343
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© © All Rights Reserved
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Implementation of cluster coding

The Independent Health and Aged Care Pricing Authority (IHACPA) is responsible
for the development of the diagnosis and intervention classifications used in
admitted care:
• International Statistical Classification of Diseases and Related Health Problems,
Tenth Revision, Australian Modification (ICD-10-AM)
• Australian Classification of Health Interventions (ACHI)
• Australian Coding Standards (ACS); collectively known as ICD-10-AM/ACHI/ACS.

What is cluster coding?


Cluster coding is a mechanism of linking related diagnosis codes through use of a diagnosis cluster identifier (DCID) that will
enhance the value of coded data.
Codes are considered ‘related’ when they connect the circumstances of an event or certain other code relationships together.

Why is cluster coding necessary?


Currently, any relationship between ICD-10-AM codes is limited to what can be determined through the sequencing of codes by
those involved in the clinical coding process. However, when complex conditions require multiple codes, sequencing alone is
not sufficient for users to understand the relationship between codes.
With cluster coding, the relationship between codes becomes clearer which adds meaning and improves the utility of the data.

Benefits of cluster coding


Clustering increases the understanding of activity data and provides more powerful information for end users by:

identifying relationships enhancing safety and enhancing reporting of


between codes quality reporting chronic conditions
e.g. multiple poisonings e.g. identifying hospital e.g. reporting all chronic
and injuries in the context acquired complications in conditions regardless of
of accompanying external unique clusters whether they meet ACS 0002
cause codes Additional diagnoses

reducing assumptions eliminating the need to supporting future preparing for a


when interpreting data review episodes of care funding models potential future
to establish relationships implementation of
between codes ICD‑11, where clustering
is a feature

IHACPA Implementation of cluster coding ihacpa.gov.au/cluster-coding 1


Implementation of cluster coding

How will it work?


All ICD-10-AM codes in an episode of care will require a DCID value.
The DCID assigned will indicate where there are relationships between codes (for example, injury, external cause, place of
occurrence and activity codes and supplementary codes for chronic conditions).
Conditions not assigned to a diagnosis or chronic condition cluster will be assigned DCID 8.

What does a DCID A: DCID


DCID look like? Conditions requiring
external cause codes
A S52.30 Fracture of shaft of radius, part unspecified
DCID Description A V03.1 Pedestrian injured in collision with car,
pick-up truck or van, traffic accident
DCID 8: A Y92.49 Unspecified public highway, street or road
Cluster for A U72 Leisure activity, not elsewhere classified
A-ZZ Any other conditions not
diagnosis codes assigned to a diagnosis or
chronic conditions cluster. 8 J44.1 Chronic obstructive pulmonary disease
with acute exacerbation, unspecified
Cluster for chronic
0 8 Z72.0 Tobacco use, current
conditions
DCID 0:
0 U82.3 Hypertension
Chronic conditions as
8 Not clustered 0 U86.2 Arthritis and osteoarthritis [primary]
per ACS 0003

Staged implementation
IHACPA is proposing to implement cluster coding from 1 July 2025, for use with ICD-10-AM Thirteenth Edition. The initial
implementation will be limited to clustering:
• codes that require or are associated with the assignment of external cause codes
• supplementary codes for chronic conditions (assigned in accordance with ACS 0003 Supplementary codes for
chronic conditions).
IHACPA may consider extending cluster coding combinations in ICD-10-AM Fourteenth Edition.

Support for implementation


To support the implementation of cluster coding, IHACPA will provide the following:

Guidelines in the Australian Coding Standards (ACS) Engagement with stakeholders


i Creation of ACS 0004 Diagnosis cluster identifier IHACPA will engage stakeholders through public
(DCID), to provide guidance on cluster coding for consultation, public forums and will conduct
Thirteenth Edition. industry briefings.

Pilot exercise to test the proposed ACS 0004


Education
Diagnosis cluster identifier (DCID)
Education on cluster coding will be available to all
IHACPA will conduct a pilot exercise in early 2024
users through IHACPA Learn.
to test the proposed classification guidelines.

Enhancements to the electronic code lists (ECLs)


Thirteenth Edition ECLs will identify codes that
require clustering. Flagging relevant codes will enable
software vendors to support the application of the
DCID and allow data collection agencies to formulate
edits that will enhance the quality and application of
the DCID.

Further information Find us online to connect with us.

To learn more about the Independent Health and Aged Care Pricing Authority, Independent Health and
get in touch with us via the details below. Aged Care Pricing Authority

(02) 8215 1100 [email protected] ihacpa.gov.au @IHACPA

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