SAPCReN

Study Name: Procedure Classification Systems?

Investigators: Dr. Stephanie Garies¹, Dr. Kerry McBrien¹

Affiliations:

1. Department of Family Medicine, University of Calgary.

Recruitment Status:

Abstract

Background: Health classification systems like the International Classification of Diseases (ICD) are essential for standardized data collection used in clinical care, research, and health system planning. Canada adopted ICD-9 for hospital reporting and physician billing in 1979, but while hospitals transitioned to ICD-10-CA in the early 2000s and are preparing for ICD-11 by 2030, most provinces still require physicians to use ICD-9 for billing. This outdated system limits the accuracy of health data and does not reflect modern clinical practice. ICD-11, released by the WHO in 2022, is digitally optimized and includes expanded diagnostic terms. Its adoption could improve billing processes, reduce administrative burden, and enhance data quality. This study responds to growing interest in modernizing physician billing systems and aims to generate policy-relevant evidence to support the transition to ICD-11 and the new procedure classification system, ICHI, in Canadian primary care.

Methods:

Objectives: This study aims to support the modernization of diagnostic and procedural coding in Canadian primary care through three key objectives. First, we will map Alberta’s Schedule of Medical Benefits (SOMB) procedure codes to two international classification systems such as CCI and ICHI to assess coverage, specificity, and gaps. Second, we will test the use of ICD-11, ICHI, and CCI in clinical settings by creating a dual-coded dataset from 6,000 patient encounters across 100 outpatient physicians in Alberta. Third, we will explore the perspectives of policy and decision-makers on the feasibility and readiness for updating physician billing systems, using qualitative interviews to inform future implementation strategies.