EmailHospital Circular 19/2004
Date Issued: 9 July 2004
Distribution: Public Hospitals
Subject: Electroconvulsive Therapy (ECT) Reporting
The following reporting standards for all ECT performed in public hospitals in Victoria apply to all separations on or from 1 July 2004, to provide a firm basis for review of ECT funding for 2005-06. One option being considered is a co-payment for ECTs within a multi-day Care Type 5x Approved Mental Health Service or Psychogeriatric Program episode.
The implementation of the reporting standards listed below may change the reported numbers and types of separations that involve ECT. Where hospitals feel these changes have impacted on the ability to meet activity targets in 2004-05 the Department will consider requests for target variations in end of year financial PYA reconciliation.
It is requested that these standards are followed for all separations on or from 1 July 2004. However the Department recognises that some time may be needed to update processes and/or systems. Therefore edits relating to these standards will not be implemented until 1 September 2004. Compliance with these reporting instructions will be a priority in the next Victorian Admitted Episodes Dataset (VAED) audit.
Background Information
It is acknowledged that over the last decade it has been unclear as to exactly how ECT should be reported in the VAED (formerly the VIMD), and reporting practice has varied accordingly. In August 2003 the DHS Hospital Admission Policy 2003-04 was released, which advocated all ECT episodes to be recorded as Care Type 5. However this was not enforced across the State due to the significant perceived funding implications for sites.
Under the Commonwealth’s Day Only Procedures Manual (which we are bound to comply with under the National Health Act 1953), Type B procedures, including all same day procedures carried out under a general anaesthetic, such as ECT, should be reported as an admitted episode. In Victoria, the requirement is that all Type B procedures must be admitted.
ECT Reporting: VAED
The Department has determined that whilst ECT is a procedure to treat Mental Health conditions, as the majority of sites have expressed the view that as ECT is either carried out in an acute setting, and/or by acute staff (including the delivery of an anaesthetic by an anaesthetist), ECT falls within the Acute Care Type.
Thus, all same day ECT (that is, where the patient is formally admitted and separated on the same day, and which is not part of an overnight Mental Health hospital stay) should be reported as a Care Type 4.
However where ECT occurs as part of an admitted Mental Health episode, in accordance with VAED Business Rules, the ECT must not be reported as a statistical separation. The appropriate ICD-10-AM procedure code should be assigned to the episode, with the ICD-10-AM general anaesthesia code repeated as many times as the ECT was performed (as per Australian Coding Standard 0031 Anaesthesia).
These reporting instructions will be incorporated into an update of the current DHS Admission Policy.
ECT Reporting: CMI/ODS (RAPID)
All ECT must (under the Mental Health Act 1986) be reported to the Office of the Chief Psychiatrist, through the ECT Register.
As well as this, all episodes involving ECT should be reported on the CMI as an admitted episode, including same day episodes reported on the VAED under Care Type 4. Same day ECT must be recorded on the CMI in a speciality ECT suite.
Scenarios
The implications of implementing the new reporting standards for ECT on the VAED may include one or more of the following:
- Hospitals currently not reporting same day ECT on the VAED will commence doing so, and will therefore receive WIES for these episodes.
- Hospitals currently admitting same day ECT as Care Type 5, will commence reporting these as Care Type 4, and will therefore receive WIES for these episodes.
- Hospitals currently (contrary to VAED Business Rules) creating statistical separations and admissions for overnight admitted mental health patients who also receive ECT, will cease to do so. The outcome will be that where there were 3 episodes per patient (as a minimum, that is two as Care Type 5, with an intervening episode of Care Type 4) there will only be one Care Type 5 episode.
- Hospitals may need to adjust their coding practices to ensure that the ICD-10-AM general anaesthesia code is repeated as many times as the ECT was performed (as per Australian Coding Standard 0031 Anaesthesia).
Any sites who are currently moving a patient from one campus to another to undergo ECT should contact Karen Walker on 03 9616 7953 for further advice.
Summary
The Department:
- Wants to change the funding of all ECTs (regardless of the length of stay of the admission) to a fairer/more equitable funding arrangement.
- Needs consistent and accurate data to be able to develop funding options to be modelled. This is reliant on the strict adoption of the reporting guidelines by all sites.
- Will consider the activity/target implications for 2004-05 on a cost neutral basis overall.
| Peter Donnelly Director, Funding and Financial Policy Metropolitan Health and Aged Care Services |
Dr Ruth Vine Director, Mental Health Metropolitan Health and Aged Care Services |
