The Australian PBS codes are used to describe the medications for which the Australian government offers rebates under the Australian Pharmaceutical Benefits Scheme. The codes are published as part of the rules definitions tables, and can be found here. In living memory, the codes have consisted of 4 digit codes followed by a alphabetical check letter. For instance, the code for a particular packaging of Simvastatin (used to be a clinical interest of mine) is “2011W”, and you can get the full details for this code at http://www.pbs.gov.au/medicine/item/2011W (note that this is not case sensitive, and http://www.pbs.gov.au/medicine/item/2011w also works).
However, the 4 digit codes are starting to run out. As I previously discussed, the PBS team won’t be reusing old codes for new meanings, so that means that they’re going to start using longer codes. That’s forecasted to happen in May/June this year.
That’s where the fun starts. From my post from before, the proper representation for a PBS code in a CDA document is this:
<code code=”1471K” codeSystem=”184.108.40.206.2001.1005.22″/>
and in a v2 message, it would be something like this:
(Though there’s no v2 registered code system for PBS – I’d like to think that means that no one is exchanging PBS codes in v2, but I think people are. We talked about defining PBS on an Australian basis, but we never formalised that)
However there’s a problem: when Medicare were updating their systems to handle longer PBS codes (something that was done last year after it was decided that PBS would use longer codes), they changed their interfaces so that the PBS code would be represented like this (quoted from one of several rules published as amendments to the National Health Act):
PBS/RPBS Item Code: Six bytes, right justified, zero filled, five bytes numeric followed by one byte alphabetic check character, being the code for the pharmaceutical benefit which appears in the Schedule of Pharmaceutical Benefits for Approved Pharmacists published by the Department of Health and Ageing. A zero code is to be used in the case of Repatriation items which are not included in the Schedule but have been prior approved by the Department of Veterans’ Affairs.
Valid values include: 0-9, A – Z. Alpha character must be in upper case.
So all the DHS/Medicare interfaces prefix the PBS code with a 0, like this: 01471K. Note that many of the medicare interfaces are fixed width file interfaces, and they don’t really have a lot of choice but to fix the width of the field, and it’s going to be either prefixed with spaces or zeroes. Whatever, the PBS Authority (DOHA) that publishes the codes doesn’t prefix with 0.
I discussed this with the team that defines the PBS codes. From their point of view, the code is an integer value, with an accompanying check character, and whether or not the integer value has any ’0′ digits prefixed to it is not significant, doesn’t affect the check digit calculation, and doesn’t affect the interpretation of the code. Whether 0 is prefixed in any given context is an implementation detail, and they are comfortable with people using either form.
Note that they don’t use prefixed codes – the ascii and xml formats that they distribute don’t include a leading 0, and http://www.pbs.gov.au/medicine/item/02011W is not found (based on the links above). That’d be the implementation aspect of it showing up.
As a side note, the PBS codes already include 2 and 3 digit codes for some special items. For instance, 183P is Chlorhexidine Acetate (use as additive only). Note that no variation of http://www.pbs.gov.au/medicine/item/183P that I could think of trying worked, so I presume that these special codes are not published through the PBS web site. Btw, they PBS team also informed me that they reserve the right to use codes longer than 5 digits in the future, but I think we can safely assume that this won’t happen since DHS can’t support it without changing their interfaces again, which isn’t going to happen any time soon.
Because one of the first document types to be uploaded to the pcEHR was the medicare records, and because they use the 0-prefixed form internally, naturally, the medicare documents contained this form:
<code code=”01471K” codeSystem=”220.127.116.11.2001.1005.22″/
And because of the way this is implemented internally in the pcEHR, the pcEHR is therefore configured to only accept the 0-prefixed form. And now vendors that are testing to their documents with the pcEHR are running into this as a problem, since they do not prefix the existing codes with 0s.
There are various possible solutions:
- Get DHS/Medicare to change to not prefix the codes with 0
- Insist that PBS codes are always prefixed with 0 values to 5 digits when they are exchanged between systems (but not displayed to users?)
- Leave it that all systems should accept codes prefixed with 0s or not and know that the code itself is the same either way
- Say that the medicare interfaces and the pcEHR documents always (and must) prefix with 0, but in other contexts, it doesn’t matter (see rule #3)
I think we can safely say that the first isn’t a good idea. The second sounds like a good idea unless one day we start using 6 digit codes, but what happens to existing interfaces? #3 sounds like a good idea, but is really tough for systems, since the codes are suffixed with an alpha character – this violates normal rules for handling code systems, and special cases are always bad. The 4th is a variation of the 3rd that spreads the pain around differently (still involves special cases).
It doesn’t seem obvious to me what is the right solution here. This blog post is to solicit opinions from the various vendors etc that are affected by this problem. You can either comment on the post here, or if that is counter to your policy, you can comment to me directly. (Note that if you have a relationship with NEHTA, and it’s necessary, you can comment to me under NDA if you wish).
At some stage I’ll have to update the registration for the code system to clarify this, but I’ll wait for now. Also, I think it’s probably necessary for us to get a v2 code system for PBS codes. Let me know if you exchange PBS codes in v2 messages.
Update (13-Feb 2013): DHS advises that: “PBS Online will accept either a zero-filled or non zero-filled PBS item code. In practice some Software Vendors zero-fill and some do not.”