Hip fractures, co-morbidities and clinical coding

Abstract

Accurate documentation is important for clinical and financial reasons. In the NHS, inaccurate or incomplete documentation can alter the health resource group (HRG) code, and hence the tariff received by a trust for patient care. We set out to analyse documentation and coding of hip fractures and the assess the impact of inaccuracies on trust revenue. From 1st August 2011, medical records of 100 consecutive patients admitted with femoral neck fractures were reviewed. Data extracted included: demographics, fracture diagnosis, operative procedures, co-morbidities and complications. The HRG coding and tariff data were obtained for the same cohort. Based on our extracted data, coding was repeated and the tariffs recalculated accordingly. The repeat coding was then compared with the original coding. Twenty-five of the 100 cases were found to have discrepancies between the HRG coding data and our repeat coding resulting in reduction in tariff. This led to a total shortfall of £17 686 in the actual tariff obtained for the cohort which, by extrapolation, translates to a predicted annual deficit of over £100 000 for the trust. In all 25 cases, missing or incomplete coding of medical co-morbidities (such as dementia, hypertension, urinary tract infection) resulted in the observed tariff loss. Inaccuracies in clinical coding of medical co-morbidities have resulted in significant tariff loss for our hospital trust. Better education for both coders and clinicians is advised, as well as more direct involvement from clinicians in the coding process.