Tricky Coding Issues II

August 9, 2016

Pharmaceutical Industry coding is a global affair, meaning many an issue may arise that can affect coding choices based on one’s geographic location and cultural understandings.  When reviewing or performing coding in regions where specificity, consistency and cultural and national differences may impact the way a medical concept is understood, it is important to grasp how those ideas could impact coding in the real world.

Specificity

Each case that is affected by specificity may have its own challenges. For instance, the term edema can have a very different medical meaning and treatment if it is pulmonary edema (which may be life threatening) as compared to leg edema (which may be only bad circulation and not life threatening).  In these cases, the specificity of the information provided is critical in determining the proper code for these terms.

Consistency

In MedDRA, there are a number of synonyms.  For example, one or more of the following codes may be used for a liver AE:  “elevated liver enzymes,” “abnormal liver enzymes,” “elevated SGOT,” “elevated SGPT,” “elevated ALT,” or “elevated AST”.  Similarly, one may code low blood glucose or hypoglycemia.  Ideally, where there are choices, the coders in a particular institution should standardize on one term and not use all the terms possible.  This may require some arbitrary choices, decisions and setting up coding conventions or manuals.

Cultural, Language and National Differences

Around the world, medical concepts may exist in one region and not be used at all in other regions. For example, the term “neurasthenia” is rarely used in the US but is frequently used in Europe).  The term angina commonly refers to chest pain in the US and general pain or throat pain in parts of Europe. Although MedDRA exists in several other languages (at the PT level and up), many coders in non-English speaking countries code in English because it is the primary language of MedDRA.  Depending upon language and medical skills this may or may not make a difference.

In the End

Don’t let you concept slip away.  Choices made in a bubble are perilous indeed.  To increase the effectiveness of your coding assets, a little education and cultural sensitivity can pave the way to a much more useful, more precise and more closely matching medical encoding.

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