gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Demand for a new procedure classification system in Austria

Meeting Abstract

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  • Karin Leitner - Medical University Innsbruck, Innsbruck, Austria
  • Andreas Egger - Federal Ministry of Health and Women, Vienna, Austria
  • Karl Peter Pfeiffer - Medical University Innsbruck, Innsbruck, Austria

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds572

The electronic version of this article is the complete one and can be found online at:

Published: September 8, 2005

© 2005 Leitner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction and Objectives

Procedure coding in Austrian hospitals is currently being performed using the MEL (Medizinische Einzelleistung) catalogue comprising roughly 1.000 items and constituting a fundamental component of the LKF system, Austria’s hospital financing system. Apart from the MEL catalogue, used exclusively in inpatient settings, several other procedure catalogues are being used by various health insurance companies, as well as a number of locally implemented catalogues for outpatient settings.

To assure better-quality documentation and supply improved data for the purposes of health care financing, planning, and research, standardization of coding practices in Austria is essential. A way to accomplish the goal of a single Austria-wide procedure catalogue for use in all patient care settings could be the development of a “meta-catalogue”. Initially, this catalogue would act as node which all other catalogues in use would be mapped to. This would allow the further use of various existing catalogues, which would ease the change process. In the course of introducing new systems in patient care, the new meta-catalogue or relevant parts thereof could be adopted, while the traditional home-grown systems could gradually be phased out. This would result in a desirable decrease in the number of different systems.

As neither the MEL catalogue nor any of the other catalogues in use have the potential of providing the structural or methodological basis for the intended meta-catalogue, a new classification system needs to be employed. Germany seems to be encountering similar problems as Austria concerning procedure coding. Aiming at replacing the German classification for procedures in medicine (currently OPS Version 2005) with a well-structured, expandable classification, meeting the needs of high-level statistical analysis, the French Classification Commune Des Actes Médicaux (CCAM) (version V0 2002, version V0bis 2003) has been given close consideration and was found to be well-suited to Germany’s needs [1], [2].

Against this background, CCAM has been investigated with respect to Austria’s current situation in the field of procedure coding. This paper reports on the first experiences mapping a sample of concepts taken from a list of procedures used in Austria, thus exploring the feasibility and practicability of adopting a CCAM-like structure for Austria’s new procedure catalogue. Furthermore, the applicability of this approach is discussed looking at the bigger picture, including a glance at international initiatives, in particular the International Classification of Health Interventions (ICHI), developed by the National Centre for Classification in Health (NCCH) for the WHO [3], [4].

Material and Methods

The procedure classification investigated was the French Classification Commune des Actes Médicaux (CCAM) (version V0bis 2003), a classification system for use in both inpatient and outpatient care. CCAM is a mono-hierarchical, multi-axial classification system comprising roughly 7.100 items within 19 chapters (version V1 2005) that primarily reflect the body systems. Each chapter is subdivided into diagnostic procedures and therapeutic procedures, respectively. The 7-character alphanumeric codes consist of four letters defining topography (characters 1 and 2, e.g. nervous system), action (character 3, e.g. alteration of the size), and mode of access or technique (character 4, e.g. open approach), followed by a three-digit enumeration [5].

For this work, a translation of the classification structure (i.e. axes topography, action, mode of access or technique) from French into German was carried out to enable a mapping of concepts to these axes.

For pilot testing, a sample of 66 items (arbitrarily selected) from a list of urologic procedures used in a Vorarlberg (Western Austria) hospital was mapped to CCAM. This process involved a semantic analysis of the terms selected with term specification according to the classification axes, thus accomplishing a more standardized vocabulary and concept structure. Consecutively, CCAM codes (limited to the first 4 characters) were assigned. Remarks were made in cases of unclear or ambiguous concepts and suggestions were made for improvements of the terminology.


Semantic analysis of the terms was essential due to inconsistent terminology and ambiguity of concepts in the list of procedures. 1:1 mapping of 50 out of 66 items was achieved following term specification according to the classification axes topography, action and mode of access or technique. In 14 cases, no code could be assigned due to ambiguity of the concepts leading to vague medical meanings and thus an inability to further specify these terms. 1:2 mapping in 2 cases also resulted from ambiguous terms where term specification led to two distinct procedures.


Following investigation of the French CCAM and the application of its structure to a sample of concepts from a list of procedures used in Austria, the overall impression was that CCAM is a comprehensive, user-friendly classification system of adequate granularity, being structured in a clinically relevant way. Its multi-axial approach promotes a standardized concept structure facilitating maintenance, mapping to and from other classifications as well as international use and comparability.

Mapping a sample of concepts demonstrated the potential of straightforward mapping to CCAM due to the clear classification structure but revealed the obvious shortcomings of Austrian procedure catalogues, i.e. inconsistent terminology, ambiguous concepts and lack of definitions.

Looking at the international scene, a number of initiatives aiming at more standardized procedure coding are under way. As already mentioned, Germany is dealing with similar issues as Austria, strongly demanding a classification suitable to replace their current aging procedure classification. Germany seems to be striving for a solution via the French CCAM. The Network of WHO Collaborating Centres for the Family of International Classifications (WHO-FIC) has promoted the development of a short list of health Interventions for international use, based on the Australian Modification of the International Classification of Diseases, 10th revision (ICD-10-AM). It is intended to be used in countries that do not yet have their own classification of interventions [4]. The proposed International Classification of Health Interventions (ICHI), developed by the National Centre for Classification in Health (NCCH) and currently in its Beta version, is now entering extensive field trials [3]. Whether ICHI could also be considered an option to serve as a basis for the proposed Austrian meta-catalogue or whether it could be employed only for international reporting remains to be investigated.

Following the experiences gained from this work, developing an Austrian meta-catalogue based on the structure of CCAM seems both feasible and practical. Whether this approach is applicable in the larger Austrian context depends on a number of factors including political interests, financing and implementation issues such as organisational change.

Further steps to be taken include more extensive testing on a larger sample of concepts from a broader range of medical specialties and of various levels of granularity. All procedure catalogues currently in use in Austria need to be included in the investigation to assess the possibilities of mapping their contents to CCAM.

Clinical staff, administrators, politicians as well as scientists need to be involved from this point in order to address all stakeholders’ interests. Other approaches apart from the one emphasised in this work, i.e. a solution via the French CCAM, should be considered. Accordingly, the International Classification of Health Interventions (ICHI) should be investigated.


DIMDI (2005) OPS Version 2005 [Online]. Available: [Accessed 20 March 2005].
Hanser S, Zaiss AW, Jakob R and Klar R (2004) How to build a well structured procedure classification from an insufficient coding system. In Fieschi M et al. (Eds) MEDINFO 2004. Amsterdam: IOS Press.
National Centre for Classification in Health (NCCH) [Online]. 2005 - last updated. Available: [Accessed 20 March 2005].
WHO (2005) International Classification of Health Interventions (ICHI) [Online]. Available: [Accessed 20 March 2005].
Classification Commune des Actes Médicaux (CCAM), version V1 (March 2005) [Online]. Available : [Accessed 20 March 2005].