Our Group proposes to standardize the way we describe and codify information for occupational injury/illness incidents. These standards will become the guiding principles for future modifications of current systems to support electronic transactions.

OVERVIEW

For decades, industry, government, and national consensus groups have been meeting both jointly and independently to design and discuss systems and schemes (hereinafter referred to as systems) for the coding of occupational injury/illness information and workers' compensation claims. The complex systems now in use affect the operations of many diverse groups, both in the private and the public sectors. Unilateral decisions or actions to change or adopt one system over another may result in conflicts among some groups and may impose additional administrative burdens on others. Uniform coding systems can only be developed when there is collaboration, consensus, and incentive for the parties involved in the process.

There now appear to be both financial benefits and data quality incentives for the adoption of a uniform coding system, especially when used in conjunction with information technology and automation of workers' compensation claims processes. These recognized incentives emerge at a unique time in history, with the calls for managers to re-engineer, reinvent, and streamline management processes and to use the power of technology to reduce administrative burdens and costs. There is now an opportunity for these diverse groups to join forces in addressing existing or potential roadblocks in determining which systems (or parts of systems) can help the community achieve uniformity and standardization in the coding and electronic transmission of occupational injury/illness data and workers' compensation claims.

BACKGROUND

A meeting of the American National Standards Institute (ANSI) Z16 Committee, Methods of Recording and Compiling Injury and Illness Statistics, in August 1996 initiated a serious dialogue among industry, public sector, and the ANSI groups studying this challenge. At that meeting, members of the ANSI Z16.2 Subcommittee, American National Standard for Information Management for Occupational Safety and Health, suggested the establishment of a series of coding standardization symposia to determine how these diverse groups could work together and address the complex barriers to standardization. As a result, invitations to attend the first symposium were extended to individuals representing the insurance industry, workers' compensation programs, safety and health programs, and state/federal government programs (hereinafter referred to as the Group). The first event was held on October 15 and 16, 1996 under the co-sponsorship of the Insurance Data Management Association and the ANSI Z16.2 Subcommittee. Three subsequent meetings were held in January, February and April 1997.

The initial symposium was devoted to discussions on the diversity of coding systems currently in use to record occupational injury/illness incidents, and the broad spectrum of data needs represented by the Group, coding systems common to the medical community for recording health encounters related to medical record keeping, government notification requirements (mortality and morbidity reports), and third-party billing. Presentations on the most commonly- used coding systems were made and the needs of participating organizations were discussed.

The objectives of the remaining symposia in the series were to determine the suitability of using a nationally recognized coding system to: (1) identify and record occupational injury/illnesses information, (2) identify occupational injuries/illnesses information for medical record keeping and health statistics, (3) meet the needs of the workers' compensation process and occupational injury/illness prevention efforts, (4) document cost responsibility for third-party payers, and (5) accommodate other reasonable business needs articulated by Group members.

STATEMENT OF VISION

Upon reviewing a variety of options, the Group recommends that the following classification structures be adopted as the standard for coding occupational injury/illness incidents:

• ICD-10-CM(1) (proposed implementation date October 1, 2000) to code Nature of Injury/Illness and Part of Body information, along with its official coding guidelines.
• ANSI Z16.2(2) Standard (OIICS(3)) to code Event, Source, and Secondary Source information, along with its official coding guidelines. (Seen by some data users as "Cause of Loss")

The Group also recommends:

· Standardizing the reporting of occupational injuries/illnesses, using standards being developed by International Association of Industrial Accident Boards and Commissions (IAIABC), in cooperation with the U.S. Department of Labor.

While the Group would have preferred to adopt one set of coding structures (one system), rather than recommending the use of multiple coding systems, no one current coding system could fulfill all of the Group's needs. These needs include: obtaining high-quality data to meet customer requirements, using a system that is compatible with all Group members' legacy computer systems, and ensuring that the chosen system(s) (or parts of system(s)) has proven credibility and recognition within the field. The consensus decision of the Group to recommend the use of a combination of specific subsets of the ICD-10-CM and ANSI Z16.2 coding systems reflects not only the intrinsic quality of the chosen coding system relative to the information to be classified, but also the customer requirement that the classifications occur at the right time in the data collection process, and be performed by those best qualified to make those determinations.

In the Group's opinion, this approach will improve the administration of occupational safety and health prevention programs by achieving a high level of data quality, increasing efficiency in the workers' compensation claims process, and significantly reducing the administrative costs of data collection. In addition, the uniform use of coding system by the medical community, the public sector, and industry will create greatly expanded opportunities to examine and analyze the characteristics of occupational injury/illness events and will provide information that can assist safety and health managers. Common coding systems will allow quick match, merge, comparison and analyses in the broad context of other health concerns.

DECISION FACTORS

A.ICD-10-CM to code Part of Body and Nature of Injury/Illness:

1. Medical Acceptance

The ICD-CM is recognized as the national standard for coding health incidents in the medical community at large, and, therefore, it is the preferred candidate for the identification of part of body and nature of occupational injuries/illnesses.

2. International Recognition

ICD is the classification system of the World Health Organization (WHO).

3. Insurance Acceptance

ICD data is now used in standardized systems developed by the International Association of Industrial Accident Boards and Commissions (IAIABC)

4. Receptivity and Collaboration

Modifications in the design of the ICD-10- CM which resulted from collaborative efforts between our Group and NCHS have provided sufficient detail to capture the diagnosis and body part elements of workers' compensation claims. The Group expects to continue its involvement in the regular update and modification process, already established for ICD-9-CM.

5. Timely Updates

There is a regular update and modification process already established for the ICD-9-CM.

6. Public Domain

ICD is in the public domain, and it may be used without paying royalties.

7. Statistical Robustness

ICD has proven analytical capacities for Part of Body, and Nature of Injury/Illness. It provides a hierarchal system which allows users to adapt the system to the level of detail required for their needs.

8. Availability of Training

Comprehensive training on the ICD-10-CM will be available for both users and coders.

B. ANSI Z16.2 (OIICS) to code Event, Source, and Secondary Source information:

1. Specialized System Design

The ANSI Z16.2 Standard adopted, as its standard, the Bureau of Labor Statistics' (BLS) Occupational Injury and Illness Classification System (OIICS). BLS specifically designed and developed OIICS for the coding of occupational injury/illness information. OIICS has proven to be the most compatible and comprehensive mechanism available for codifying the Event, Source, and Secondary Source information from occupational injury/illness incidents.

2. Widespread Acceptance and Usage

ANSI Z16.2 is currently used by the Bureau of Labor Statistics (BLS), American National Standards Institute (ANSI), National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), National Safety Council (NSC), and several state agencies charged with coding occupational injury/illness data.

3. Insurance Acceptance

The IAIABC-proposed standards for event, source and secondary source coding will be based on the ANSI Z16.2 coding structures.

4. Timely Updates

A systematic process has been established by the ANSI Z16.2 Committee to update its codes, as needed, and to provide its users with detailed interpretations of the application of the ANSI Z16.2 codes to occupational injury/illness incidents.

5. Public Domain

ANSI Z16.2 adopted the OIICS as its standard; OIICS is in the public domain; and OIICS may be used without the payment of royalties.

6. Statistical Robustness

ANSI Z16.2 has proven analytical capacities for Event, Source, and Secondary Source. ANSI Z16.2 also provides a hierarchal system which allows users to adapt the system to the level of detail required for their needs.

CONCLUSION

By following the Group's recommendations:

1. Using a combination of specific subsets of the ICD-10-CM and ANSI Z16.2 (OIICS) codes for occupational injury and illness data, it is the Group's belief that this proposal will enable the right people, to collect theright information, at the right time. Physicians and health care workers are the primary source of medical diagnostic information, and employers/employees are the primary source of information on how the occupational injury/illness occurred and what occupational events led up to the incident.
2. Duplication and overlap of coding are significantly reduced, since it is not necessary for data users to process both ICD and ANSI Z16.2 codes for the same types of occupational injury/illness information.
3. Significant cost savings are achieved by using a single data flow, eliminating multiple forms and coding systems to gather similar data, enhancing comparability and data analyses, and simplifying data collection processes.
4. Communications are made easier and uses of coded data become uniform under this format because everyone will be using the same data systems for any given set of data. The Group believes that closer communication among all participants in the collection and distribution of these data will assist in the development and adoption of standardized language for reports and data analyses.
5. The use of standard language for the reporting and discussions of injury and illness events facilitates communication between the many industries using the data for the design of safety and health programs, and advances the education of health care professionals, as well as those representing the insurance industry, statisticians, workers' compensation authorities, and state and federal programs.

Ultimately, the employer, the employee, and the community at large benefit from the implementation of these recommendations.

GROUP MEMBERS

Ruth H. Berger, Health Scientist
U.S. Dept. of Labor, OWCP

Gerry Berenholz, Consultant
Berenholz Consulting Associates

Elyce Biddle,
Division of Safety Research, NIOSH

Amy L. Blum, Medical Classification Specialist
National Center for Health Statistics

Richard P. Boehning, President
American Insurance Services Group

Arthur R. Cadorine
Insurance Services Office

Eileen Clark, Director, Bureau Submissions Unit
CIGNA

Frank S. Crowell, Stat. Advisor, Actuarial Statistics
NCCI

David K. Dickson, Manager - RSIP
Liberty Mutual Insurance Cos.

Carol F. Eskola, Assistant Vice President
Crawford & Company

George Gomez, Executive Director
IAIABC

Manuel Gomez, Director, Scientific Affairs
American Industrial Hygiene Association (AIHA)

Connie Wrench, representing AIHA

Mike Hembrock, Manager, Workers
Compensation Loss Control, Chubb & Son, Inc.

Peter Horewitch, Information Systems & EDI Education
IAIABC

Alan F. Hoskin, Secretary, ANSI Z16 Committee,
National Safety Council

Angela Jean
California Institute for Public Risk Analysis

Julius C. Jimeno, Chair, ANSI Z16.2 Committee, and
Director, SHEMD, USEPA

David J. Lundquist, Consultant
Booz×Allen & Hamilton

Sylvia Marek, Claim Register & Spec. Proj. Coord.
Kemper Insurance Company

Peter A. Marotta, Assistant Vice President, Data Management
Risk Enterprise Management, Ltd.

Edward Marynowitz, Director, Rating Department
PA & DE Comp. Rtg. Bureau

Gerald F. Murphy, Vice President
American Insurance Services Group, Inc.

Richard L. Penberthy, Director
Insurance Data Management Association

Scott Richardson, Chief Safety Info. Systems
Texas Workers' Compensation Commission

Janet Skinner, Manager, Database Develop.
American Insurance Services Group, Inc.

Jeffrey F. Snow Chair, IAIABC EDI Development Committee, RSIP

Nancy A. Stout, Acting Deputy Director
Division of Safety Research Nat'l Inst. (NIOSH)

Guy Toscano, Economist
Bureau of Labor Statistics

William L. Weber, Acting Assistant Commissioner
Bureau of Labor Statistics

Thomas B. Wegener, Project Manager
New York State Workers' Compensation Board

Janice Windau, Epidemiologist, BLS

Gregg D. Kaplan, Senior Claims Specialist
NCCI

Gary W. Knoble, Assistant Vice President,
Data Management, The Hartford

Kathy LaFemina, Terminal Manager
Chubb & Son, Inc.

Lori Ganni
Colorado Dept of Labor & Employment

Al Mangone, Director, GL & Service Retail
Alliance of American Insurers

(1) ICD-10-CM, International Classification of Disease, 10th Revision, Clinical modification

(2) ANSI Z16.2 Standard, American National Standard for Information Management for Occupational Safety and Health, adopts the Bureau of Labor Statistics' (BLS) OIICS as the ANSI Z16.2 Standard.

(3) OIICS is contained in BLS's Occupational Injury and Illness Classification Manual, December 1992. The text of the OICCS Manual is published in the BLS internet World Wide Web Page (http://www.bls.gov/oshhome.htp).