Rwanda Medical Procedure Coding (RMPC) system

The Rwanda Medical Procedure Coding (RMPC) system was developed by Rwanda Ministry of Health to harmonize procedure coding with an international standard.  This exercise is a critical foundation for many important reforms within the health sector, including widespread implementation of electronic medical records systems, interoperability of provider billing systems with health insurance claims management, and costing/tariff setting for streamlining provider payment mechanisms. 

Medical coding is the process of translating the narrative description of diseases, injuries, medical procedures and observations into numeric or alphanumeric code sets.  These code sets provide a standardized language that allows for a variety of applications within healthcare including statistical analysis and research of diseases and therapeutic actions, reimbursement of insurance claims between providers and payers, and knowledge-based and decision support for clinical treatment.

The Rwanda Ministry of Health has also recognized the need to harmonize both disease and procedure coding.  A  sub-set of ICD-10 codes have been proposed for disease coding (download list here). These coding systems have been developed for use across the whole healthcare delivery system, including both the public and private sectors at all levels of healthcare delivery. The linkage between diagnostic codes and medical procedure will be critical should Rwanda move towards diagnostic related groups (DRG) as a provider payment mechanism.

The coding system design and development was carried out with USAID support through Management Sciences for Health (MSH)\; a professional coding company, the American Academy of Professional Coders (AAPC); and a local consultant.

The RMPC is structured around the framework of the Australian Medical Benefits Scheme (MBS) procedure codes.  You can download a copy of the current list here

The users of the new codes will be supported by paper-based and electronic tools, including:

• Printed coding “cheat sheets”:  These list codes commonly used in different levels of the system by different specialty.  An example of a one page cheat sheet for urology services is available here.

• A standardized medical claim form: This will be required from all health care providers as part of billing to the different insurance providers.  It includes columns for both diagnostic and procedure codes.  See example here.

• A terminology server: This is a web-based system that enables MOH staff to maintain the code lists (add, update codes and nomenclature) as well as to search for procedure codes on line.

• Electronic Medical Record system (EMR): Code lists will be incorporated into the EMR so that when providers are entering patient records, they can easily look up both diagnostic and procedure codes.  Once the system is fully implemented, the EMR system will automatically update the code lists and associated data by pulling data from the terminology server.

All health care providers (particularly those recording diagnoses and involved in billing) as well as insurance staff involved in claims processing and verification must be trained to use these codes.

The RMPC is a living database of medical acts and procedures beginning with nearly 4,000 procedures.

It is anticipated that the implementation of these harmonized medical procedures and acts in both Public and Private healthcare facilities in Rwanda and coding them using internationally established classification framework will improve the healthcare system in Rwanda in several respects:

• Enhance clinical delivery and epidemiological control.
• Provide the foundation for maturing the current health financing system by making billing and claims processing standardized and more efficient.
• Enable the country to realize full benefits of their EMR system and provide structure to build more advanced automation such as claims processing, data capture and reporting.
• Provide a basis of comparability with the rest of the world on how Rwanda is improving in the healthcare service delivery.