Accuracy Of Clinical Coding Research Articles

Improving clinical coding in otorhinolaryngology

In the English NHS Payment by Results system, clinical coding of a surgical operation results in one of a range of healthcare resource groups (HRG), each of which has a specific payment national tariff that the hospital receives for each spell of care. Our aim was to audit the clinical coding of our adult otolaryngology operations with a view to prospectively improve coding accuracy and ensure appropriate reimbursement via national tariffs. We reviewed the clinical coding of operations at the end of each month, before national submission of data, over a 9-month period. Using a system that groups operation codes according to anatomical site/type we analysed cases to see if the OPCS codes recorded for the procedure reflected the actual procedure performed or whether accuracy could be improved. Over the 9-month period there were 1087 operations; 1057 (97.2%) were coded accurately and 30 (2.8%) were suboptimally coded, but when corrected for accuracy resulted in a total increase in national tariff income of £33 364. A system that groups related operation codes according to anatomical regions and types of procedure, aids the accuracy of clinical coding. It may be used before coding submission national deadlines to ensure that the appropriate remuneration is received via national tariff, for the care delivered.

An audit of the nature and impact of clinical coding subjectivity variability and error in otolaryngology

To audit the accuracy of clinical coding in otolaryngology, assess the effectiveness of previously implemented interventions, and determine ways in which it can be further improved. Prospective clinician-auditor multidisciplinary audit of clinical coding accuracy. Elective and emergency ENT admissions and day-case activity. Concordance between initial coding and the clinician-auditor multi-disciplinary teams (MDT) coding in respect of primary and secondary diagnoses and procedures, health resource groupings health resource groupings (HRGs) and tariffs. The audit of 3131 randomly selected otolaryngology patients between 2010 and 2012 resulted in 420 instances of change to the primary diagnosis (13%) and 417 changes to the primary procedure (13%). In 1420 cases (44%), there was at least one change to the initial coding and 514 (16%) health resource groupings changed. There was an income variance of £343,169 or £109.46 per patient. The highest rates of health resource groupings change were observed in head and neck surgery and in particular skull-based surgery, laryngology and within that tracheostomy, and emergency admissions, and specially, epistaxis management. A randomly selected sample of 235 patients from the audit were subjected to a second audit by a second clinician-auditor multi-disciplinary team. There were 12 further health resource groupings changes (5%) and at least one further coding change occurred in 57 patients (24%). These changes were significantly lower than those observed in the pre-audit sample, but were also significantly greater than zero. Asking surgeons to 'code in theatre' and applying these codes without further quality assurance to activity resulted in an health resource groupings error rate of 45%. The full audit sample was regrouped under health resource groupings 3.5 and was compared with a previous audit of 1250 patients performed between 2007 and 2008. This comparison showed a reduction in the baseline rate of health resource groupings change from 16% during the first audit cycle to 9% in the current audit cycle (P < 0.001). Otolaryngology coding is complex and susceptible to subjectivity, variability and error. Coding variability can be improved, but not eliminated through regular education supported by an audit programme.

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis

This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. There were 16693 patients at a total cost of AU$178.7million. The total costs incurred by trauma centres were $14.7million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P<0.001). AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. WHAT IS KNOWN ABOUT THIS TOPIC? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. WHAT DOES THIS PAPER ADD? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Further work should be conducted between trauma services, clinical coding and finance departments to improve the accuracy of clinical coding, review funding models and ensure that AR-DRG allocation is commensurate with the expense of trauma treatment.

The accuracy of clinical coding for diverticular disease and the implication for trainees intending to undertake research

The accuracy of clinical coding for diverticular disease and the implication for trainees intending to undertake research

Assessing the Accuracy of Clinical Coding in Orthopaedic Day Surgery Patients

The NHS is funded via a 'payment by results' system, whereby hospitals are paid for the work they do instead of being allocated a certain amount to spend each year. Every patient treated in hospital is coded to a Healthcare Resource Group (HRG) based on the specifics of his or her admission. There are numerous HRGs, with each one reflecting particular levels of resources that would have been used.

Accuracy of clinical coding for oral and maxillofacial surgery (OMFS) procedures

Introduction: Clinical coding involves translation of surgical terminologies into a form which can be easily gathered and analysed at a later date facilitating growth and sharing of knowledge. However, the accuracy of collected data is paramount for this to happen. Most importantly, clinical coding has significant financial implications and any discrepancy in the assigned codes would directly affect a department's (and a hospital's) budget.

Is your department losing money? An audit on the accuracy of clinical coding for oral and maxillofacial procedures

Is your department losing money? An audit on the accuracy of clinical coding for oral and maxillofacial procedures

Accuracy of clinical coding from 1210 appendicectomies in a British district general hospital

AimsThe primary aim of this study was to assess the accuracy of clinical coding in identifying negative appendicectomies. The secondary aim was to analyse trends over time in rates of simple, complex (gangrenous or perforated) and negative appendicectomies. MethodsRetrospective review of 1210 patients undergoing emergency appendicectomy during a five year period (2006–2010). Histopathology reports were taken as gold standard for diagnosis and compared to clinical coding lists. Clinical coding is the process by which non-medical administrators apply standardised diagnostic codes to patients, based upon clinical notes at discharge. These codes then contribute to national databases. Statistical analysis included correlation studies and regression analyses. ResultsClinical coding had only moderate correlation with histopathology, with an overall kappa of 0.421. Annual kappa values varied between 0.378 and 0.500. Overall 14% of patients were incorrectly coded as having had appendicitis when in fact they had a histopathologically normal appendix (153/1107), whereas 4% were falsely coded as having received a negative appendicectomy when they had appendicitis (48/1107). There was an overall significant fall and then rise in the rate of simple appendicitis (B coefficient −0.239 (95% confidence interval −0.426, −0.051), p = 0.014) but no change in the rate of complex appendicitis (B coefficient 0.008 (−0.015, 0.031), p = 0.476). ConclusionsClinical coding for negative appendicectomy was unreliable. Negative rates may be higher than suspected. This has implications for the validity of national database analyses. Using this form of data as a quality indictor for appendicitis should be reconsidered until its quality is improved.

Increased length of inpatient stay and poor clinical coding: audit of patients with diabetes

ObjectivesPeople with diabetes stay in hospital for longer than those without diabetes for similar conditions. Clinical coding is poor across all specialties. Inpatients with diabetes often have unrecognized foot problems. We wanted to look at the relationships between these factors.DesignA single day audit, looking at the prevalence of diabetes in all adult inpatients. Also looking at their feet to find out how many were high-risk or had existing problems.SettingA 998-bed university teaching hospital.ParticipantsAll adult inpatients.Main outcome measures(a) To see if patients with diabetes and foot problems were in hospital for longer than the national average length of stay compared with national data; (b) to see if there were people in hospital with acute foot problems who were not known to the specialist diabetic foot team; and (c) to assess the accuracy of clinical coding.ResultsWe identified 110 people with diabetes. However, discharge coding data for inpatients on that day showed 119 people with diabetes. Length of stay (LOS) was substantially higher for those with diabetes compared to those without (± SD) at 22.39 (22.26) days, vs. 11.68 (6.46) (P < 0.001). Finally, clinical coding was poor with some people who had been identified as having diabetes on the audit, who were not coded as such on discharge.ConclusionClinical coding – which is dependent on discharge summaries – poorly reflects diagnoses. Additionally, length of stay is significantly longer than previous estimates. The discrepancy between coding and diagnosis needs addressing by increasing the levels of awareness and education of coders and physicians. We suggest that our data be used by healthcare planners when deciding on future tariffs.

Variation of rates, accuracy of clinical coding and predictive value of inflammatory markers for removal of a normal appendix in 1210 appendicectomies

Variation of rates, accuracy of clinical coding and predictive value of inflammatory markers for removal of a normal appendix in 1210 appendicectomies

Financial and clinical governance implications of clinical coding accuracy in neurosurgery: A multidisciplinary audit

Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to £111 revenue-loss per patient episode and projected to £171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

Improving clinical coding accuracy

This audit highlights three main areas of concern under the new Payment by Results system – the inaccurate coding, the overly complex coding system and the inappropriate HRG rating for some procedures. We were, however, disappointed that the authors did not have any intervention to suggest to improve things. We feel that it is the clinicians' responsibility to make sure that their activity is properly coded and the NHS trust's responsibility to make sure that changes happen to make sure that there is appropriate payment for procedures. In a previously published audit,1 we increased the accuracy of coding from 69% to 95% in a single cycle. This was done by: Agreeing between consultants and the coding department on how different procedures should be coded. Educating clinicians on the importance of coding and making them responsible for coding their procedures. Weekly meetings between the coding department and a clinician to discuss difficult cases and educate the department on different procedures. By addressing these fundamental areas of coding, we were able to produce a significant difference in coding accuracy.

Accuracy of clinical coding in ENT day surgery

Accuracy of clinical coding in ENT day surgery

Re: A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment‐by‐results

Re: A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment‐by‐results

A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment‐by‐results

To audit the accuracy of otolaryngology clinical coding and identify ways of improving it. Prospective multidisciplinary audit, using the 'national standard clinical coding audit' methodology supplemented by 'double-reading and arbitration'. Teaching-hospital otolaryngology and clinical coding departments. Otolaryngology inpatient and day-surgery cases. Concordance between initial coding performed by a coder (first cycle) and final coding by a clinician-coder multidisciplinary team (MDT; second cycle) for primary and secondary diagnoses and procedures, and Health Resource Groupings (HRG) assignment. 1250 randomly-selected cases were studied. Coding errors occurred in 24.1% of cases (301/1250). The clinician-coder MDT reassigned 48 primary diagnoses and 186 primary procedures and identified a further 209 initially-missed secondary diagnoses and procedures. In 203 cases, patient's initial HRG changed. Incorrect coding caused an average revenue loss of 174.90 pounds per patient (14.7%) of which 60% of the total income variance was due to miscoding of a eight highly-complex head and neck cancer cases. The 'HRG drift' created the appearance of disproportionate resource utilisation when treating 'simple' cases. At our institution the total cost of maintaining a clinician-coder MDT was 4.8 times lower than the income regained through the double-reading process. This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.