Counting the cost of high priced consumables used in theatre.

Abstract

Sir, Accurate coding of procedures during a patient’s admission to hospital is essential for reimbursement through the payment by results system. However, some highly priced products do not form part of the standard tariffs and have to be coded separately using their generic rather than brand names. One such group of products is the fibrin tissue adhesives or fibrin sealants. These are commonly used in theatre to aid haemostasis. The authors conducted an audit to ascertain their use, coding and financial reimbursement. The use of two products (Tisseel, Baxter UK Ltd, Berkshire, and Evicel, Ethicon/ Johnson & Johnson Medical Ltd, Berkshire) was analysed between August 2015 and January 2016. Data were extracted from theatre records and operative notes. Coding of these products within the index admission was ascertained from the coding department. Eighty two units of fibrin sealant were used during the 6-month period. Of these, 53 (64.6%) were recorded in the operative notes, but only as brand names. None of the 82 units were therefore coded by the coding department, meaning that their cost, approximately £37 151, was not reimbursed to the surgical department. The groups using the most units of fibrin sealant were hepatobiliary and vascular surgery. This represents a significant loss of income as a result of poor understanding of documentation requirements and subsequent coding of fibrin sealants. This could be improved by educating users to document generic names rather than brand names. The authors reiterate that inaccurate documentation of high priced products used during procedures leads to poor coding and loss of income to trusts. Muhammad Kabeer Senior Clinical Fellow Department of Vascular Surgery Central Manchester University Hospitals NHS Foundation Trust Manchester M13 9WL (nexuskabeer@aol.co.uk) Achunike Okoli Surgical Pharmacist Department of Pharmacy Central Manchester University Hospitals NHS Trust Manchester Naseer Ahmad Consultant Vascular and Endovascular Surgeon Department of Vascular Surgery Central Manchester University Hospitals NHS Trust Manchester