Dear Accident Compensation Corporation,

I am writing to seek under the Official Information Act 1982, ACC's Chief Executive Scott Pickering's written clarifications/explanations associated with several questions that relate directly to ACC's decision found in ACC's official Information distributed via ACC's website at http://www.acc.co.nz/for-providers/lodge..., in which ACC instruct ACC treatment providers to -

" record the lowest relevant level of Read Code"

when recording and reporting for claims purposes on behalf of ACC claimants, the treatment providers diagnoses in terms of class of injury/ies and the use of the correct and comparable read codes.

My requests for Mr Pickering's explanations/clarifications to my questions first require the context of ACC's current position to be highlighted;

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The following is quoted directly from http://www.acc.co.nz/for-providers/lodge... ;

"About Read Codes
Each Read Code has five characters. If a code only has four numbers, it will end in a dot, which becomes its fifth character.

Primary care providers are required to record Read Codes for all diagnosed injuries for ACC claims. Hospitals or secondary care providers can use International Classification of Diseases: 10 (ICDICD-10) codes instead, although can and often do also provide Read Codes.

Having the correct Read Code helps ensure we’re covering the correct injury/injuries and providing the client with the most appropriate and timely support, rehabilitation and treatment.

Choosing a Read Code
When completing an ACC claim form, eg.ACC45 Injury Claim Form, ACC 18 Medical Certificate, and ACC32 Request Approval for further treatments please:

use the Read Code that best correspond to your diagnosis of your patient’s injury
record the lowest relevant level of Read Code
use a separate Read Code for each injury for a client with multiple injuries in the order of severity/complexity
ensure that each Read Code includes the dot, if necessary.
If there’s no Read Code to match your diagnosis, use Code Z (unspecified condition) and provide a detailed written diagnosis. An ACC staff member will complete the Read Code field. If we need to clarify anything, a case owner will get in touch with you.

If you do not have access to the full Read Code directory via Read Code software, ACC can provide a quick Read code reference list sorted by type and location of injury if you need one. Use this link ACC6343 Read Code reference list (XLS 3.5M) to download the reference list. You can also follow these links for Read Codes commonly used in Physiotherapy, Osteopathy and Chiropractic.

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And the following is quoted directly from ACC's "Consumer Outlook Group Update" titled "Read Codes" with the reference shown the the bottom left hand side of the second page of the communication as being ACC7540 June 2016;

"ACC case owners don't know when to update Read Codes.

Sometimes, a Read Code may be recorded incorrectly at the time of injury. For example an injury may initially be recorded as a sprained ankle, and a later x-ray confirms that it is in fact a fracture, or the most serious injuries are recorded at the time of injury, but a secondary injury may be missed. This can result in the Read Code needing to be updated at a later stage.

In the past there has not been a formal process for providers to notify ACC of a change in diagnosis, or for case owners to know when they need to update the system."

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The ACC7540 June 2016 Read Code Update went on to note that as a result:
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"To make it clear what medical evidence is required:

. The ACC Treatment Provider Handbook and ACC website have been updated, clearly showing what should be provided and how"....

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In the context of the above official information distributed by the Accident Compensation Corporation Limited, I seek Mr Scott Pickering's written clarifications/explanations to my following questions, in respect to how ACC have decided to instruct ACC regulated treatment providers on how the treatment provider is to record and report to ACC on behalf of their injured patients under section 49 of the Accident Compensation Corporation 2001 their patient's covered injuries.

Question 1.

"Under Choosing a Read Code" on ACC's website http://www.acc.co.nz/for-providers/lodge..., ACC first describe best treatment provider diagnosis practice by advising treatment providers to, and I quote;

"- use the Read Code that best correspond to your diagnosis of your patient's injury."

ACC has then decided to instruct treatment providers in the in the very next bullet point at the same website that treatment providers must;

"- record the lowest relevant level of Read Code."

ACC's statement that a treatment provider must record the lowest relevant level of Read Code, is in direct conflict with ACC's proceeding statement that recognises that a treatment provider if applying best diagnosis practice, is required to actually "use the Read Code that best correspond to the diagnosis of your patient's history"

Question 1 (a)

It would be appreciated Mr Scott Pickering if you would confirm/explain why ACC has sort to influence ACC treatment providers into recording and reporting the lowest relevant level of Read Code, as opposed to using the Read Code that best correspond to the treatment providers' diagnosis of their patient's injury/ies.

Question 1 (b)

Do you agree Mr Scott Pickering that by encouraging ACC regulated treatment providers to "record the lowest relevant level of Read Code" increases the potential for misdiagnosis in terms of either;

i). the underestimation of a treatment providers diagnosis of their patient's injury/ies, and hence the increased chance that a claimant's correct injuries will be unnecessarily delayed in being assessed, treated and rehabilitated?

ii) . the lack of reporting of additional/comorbid and or minor injuries associated with the accident and hence the increased chance that a claimant's correct injuries will be unnecessarily delayed in being assessed, treated and rehabilitated?

Question 1 (c)

Do you agree Mr Scott Pickering that by a treatment provider "recording the lowest relevant level of Read Code" any resultant underestimation of the patient's injuries, or omission of comorbid injuries by a treatment provider engaging in this practice, given that the read codes allocated by the treatment provider are used to guide assessment, treatment and rehabilitation, has the direct potential to lead to the patient's injuries receiving less financial assistance from ACC with respect to the patient's assessment, treatment and rehabilitation needs for their injury/ies, based on ACC encouraging treatment providers to engage in a practice of recording the lowest relevant level of Read Code?

Question 1 (d)

Mr Scott Pickering can you please confirm if ACC have a specific financial measure (in terms of liability release (i.e. savings to acc for underestimated claims costs or unreported claims costs or both) that quantifies the benefit to ACC in terms of influencing treatment providers to recording the lowest relevant level of Read Code for their patient's injuries? If so can you please confirm what they are and how they are measured.

Question 2.

In reading ACC's website http://www.acc.co.nz/for-providers/lodge... it is clear that ACC does not have a specific claim form that allows treatment providers to add comorbid injuries that were originally missed by treatment provider's/s' first assessment, and or the correction of a treatment providers prior diagnosis.

In fact ACC's referred website encourages treatment providers to use inappropriate ACC forms for the changing and adding of injury diagnosis to a patient's covers by a treatment provider.

ACC's website on Read Codes stipulates that a treatment provider must use either an ACC 18 Medical Certificate, or an ACC 32 which is a Request Approval for further Treatrments which are both inappropriate forms for the addition and or amendnment of treatment providers diagnoses.

Question 2 (a)

It would be appreciated Mr Scott Pickering if you could confirm why ACC has neither a specific form and or web based electronic treatment provider registration process for either;

i). the correction to an earlier treatment providers proven incorrect Read Code diagnosis associated with an ACC 45 number then claim number, and similarly another specific ACC form or electronic treatment provider registration process for

ii). treatment providers being able to add additional Read Codes under an existing ACC 45's number then claim number, for the diagnosis of additional injuries that were sustained in the same accident which had previously gone unreported for what ever reason.

An example would be the situation where a g/p diagnosis of lumbar strain after a patient's fall and sends their patient to a physiotherapist, osteopath or chiropractor and then they through their fuller assessment further diagnose that the patient has associated injuries to their buttocks, and thoracic spine which went undiagnosed by the GP.

There is no specific ACC form or ACC process that can be easily updated by the secondary treatment provider (physio, chiropractor, osteopath etc) at the exact time of the further injuries being diagnosed by the treatment provider who is not the patient's GP.

Question 2 (b)

Do you think Mr Scott Pickering that given current information technology capabilities ACC has a duty of care to accidentally injured clients' to ensure that when an additional injury/ ies is or are subsequently diagnosed by either the initial treatment providers further assessment, or a subsequent treatment provider, and which were unfortunately missed in the first assessment are correctly claimed for by treatment provider when they subsequently come to light and diagnosed, that they are immediately lodged by the treatment provider by way of either the lodgement of a specific new ACC form or by way of ACC enabling a specific electronic ACC process that allows the treatment provider to register the additional classes of injuries with ACC by computer for claims acceptance and entitlement cover? In either method the ACC claimant walks away from the treatment providers office/treatment rooms with a copy of the new additional injury/ies registration submitted to ACC by the treatment provider for their records.If not why not?

Question 2 (c)

Do you think Mr Scott Pickering that given current information technology capabilities ACC has a duty of care to accidentally injured clients' to ensure that when an incorrect diagnosis is established and a proven correct diagnosis is subsequently diagnosed by either the initial treatment providers further assessment, or a subsequent treatment provider, that the new correct diagnosis is immediately lodged by the treatment provider by way of either the lodgement of a specific new ACC form or by way of ACC enabling a specific electronic ACC process that allows the treatment provider to register the additional classes of injuries with ACC by computer for claims acceptance and entitlement cover? In either method the ACC claimant walks away from the treatment providers office/treatment rooms with a copy of the new additional injury/ies registration submitted to ACC by the treatment provider for their records. If not why not?

I thank you for your time and assistance and respectfully request that under s16(2) of the Official Information Act, my preferred way of receiving a response is by email to the address from which ACC received the original request, not by post.

Yours faithfully,

David Lawson

Dear Government Services,

I refer to your correspondence dated 23 May 2017.

It is noted that your referred correspondence does not accurately acknowledge the official information that I have requested in my OIA dated 15 May 2017 in it's original entirety and form, and can only be achieved and when Government Services quotes back in their acknowledgement letter my OIA requests in full.

In ACC Government Services inactions in having not quoted back to me my original OIA requests in your correspondence dated 23 May 2017, ACC Government Services have left open the potential for confusion and ambiguity on the part of ACC Government Services to be able to interpret incorrectly and consequently respond incorrectly under the OIA Act to my OIA requests of 15 May 2017.

To remove any and all possible potential future delay in ACC Government Services' full provision of the official information that I have requested in my OIA request of 15 May 2017, I respectfully request that in ACC Government Services written response on ACC letter head due on or before the end of business close on 13 June 2017 is set out with each of my specified questions fully re-quoted in said correspondence, followed by the Official Information response asked for.

I have also just picked up on the fact that under Question 1 (b) and Question 1 (c) in my OIA request of 15 May 2017, that I forgot to add after Questions 1 (b) and 1 (c) the follow up questions- "If not, why not?", and I therefore respectfully request that "If not, why not?" is added for Mr Scott Pickering's response to both Question 1 (b), and 1 (c) of my original OIA requests of 15 May 2017.

I thank you for your time and assistance.

Yours sincerely,

David Lawson