Clinical coding: are trusts being short-changed?

Abstract

Introduction: Clinical coding is important for financial payment, financial planning, provision of healthcare services, monitoring of health trends, audit, research and clinical governance. Coding among NHS trusts is performed by non-clinicans. The authors carried out an audit at Morriston Hospital, Swansea, to compare the difference between the way in which the coders and a surgeon coded for orthopaedic procedures. Morriston Hospital also receives tertiary referrals for more complex procedures that standard district general hospitals are unable to perform. Therefore, it also functions as a specialist trust. Methods: The authors undertook a retrospective analysisof 45 patient case notes of orthopaedic patients who had both trauma and elective orthopaedic surgery. These were first coded by the coder and then independently coded by the surgeon. Results: Clinical coders vs surgeons: Different code and different healthcare resource group (HRG) = 18%. Same code and same HRG = 33%. Different code and same HRG = 49%. Lost renumeration as a result = £4663 (over 1 month). Conclusions: Coding is often subject to inaccuracies due, in part, to the clinical coders (non-medical staff) and this could be improved. The coding system is flawed and generates inaccurate HRGs. Financial loss or gain can be a result of these flaws and inaccuracies. This is unacceptable for such a large organisation like the NHS, and is detrimental to individual trusts - both financially and for the provisionof health care.