Health-care-related harm: when the model does not apply

Not every complication is harm

Not every complication is care related harm. A condition that follows care is not always caused by it.

An explicit causal link

WHO is clear on the test. The three-part model applies when the documentation explicitly links an aspect of care to the condition. Words like after, following, or on day three declare timing only, and merely mentioning a procedure doesn't mean it played a causal role.

Code the condition and its timing

When there's no explicit link, code the medical condition from whichever chapter it belongs to, with an extension code for timing: developed after admission, and optionally postoperative.

• Condition · Any chapter · Code the medical condition from the chapter where it belongs.
• Timing · XY69&XY7V · Developed after admission, with an optional postoperative flag.

The context decides

Overdose or poisoning? The context decides. An overdose of a prescribed medication, in a therapeutic context, uses the health care related harm codes. A child ingesting pills from a bottle, or an intentional overdose for self-harm, is coded as poisoning. Intentional self-harm overrides other considerations.

It is hard in practice

In the China national pilot, one three-part model case reached only fifty-one point seven percent accuracy, and among coders who got the harm right, thirty-six point two percent then erred on the cause or mode. The authors recommend more education on the model.

• 51.7% · China pilot · Accuracy on one three-part model case in the national pilot; among those who got the harm right, 36.2% erred on cause or mode.

Check yourself

Pause and think. There is no explicit causal link. What do you code? The answer: The medical condition, with an extension code for timing. When there is no explicit link, code the medical condition from the chapter it belongs to, with an extension code for timing.

• The harm, cause and mode anyway
• Only the procedure
• The medical condition, with an extension code for timing
• Nothing

Keep these in mind

An explicit causal link, or no model. Otherwise the condition plus timing extensions. And a therapeutic context means health care harm, otherwise poisoning.

• Explicit causal link, or no model
• Otherwise: condition plus timing extensions
• Therapeutic context means harm; otherwise poisoning