Does a coding sticker for percutaneous nephrolithotomy improve clinical coding accuracy and increase financial remuneration?

Objective: This study aimed to evaluate whether a coding sticker for percutaneous nephrolithotomy (PCNL), completed by the surgeon after the operation note, improved the accuracy of clinical coding and the financial remuneration for PCNL. Patients and methods: A retrospective study was undertaken including all PCNLs performed in a single centre between October 2014 and June 2016. PCNL clinical coding was obtained and applied to yield a Healthcare Resource Group (HRG) code, which was in turn used to calculate the tariff the Trust received for the case. Remuneration and clinical coding accuracy were compared pre- and post-coding sticker introduction. Results: Thirty-three cases were included in the study. Eleven patients were reviewed before the introduction of the sticker and 22 after the introduction of the PCNL sticker. Overall mean clinical coding accuracy improved from 65% to 94% after the stickers’ introduction. This resulted in an overall mean increase in remuneration of £501 per case (from £2946 to £3447). Conclusion: The implementation of a simple coding sticker for completion after a PCNL improves clinical coding accuracy and increases the financial remuneration.

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.

Audit of Clinical Coding of Major Head and Neck Operations

INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.

The Cost of Shoulder Arthroscopy: A Comparison with National Tariff

INTRODUCTION ‘Payment by results’ was introduced with the aim of providing each trust with a transparent and fair remuneration for the work done. Hospitals are paid a tariff for each Healthcare Resource Group (HRG). The tariff is calculated at a national level, by means of a complex manipulation of historic financial data. However, the financial viability of a hospital relies on these payments and so accuracy is vital. PATIENTS AND METHODS We conducted a cost analysis of shoulder arthroscopic procedures carried out at an elective orthopaedic unit. This unit is self contained and well audited, providing an unique opportunity to make a more accurate cost analysis. We calculated the cost of the facility, consumables/implants, anaesthetics and staff pay. This was then compared with the amount paid to the trust. RESULTS All arthroscopic operations performed at our institution attract a tariff of £1780. Our cost of a subacromial decompression was £1307, a profit of £473. A rotator cuff repair was £2672, a loss of £892. CONCLUSIONS The tariff is inaccurate. The arthroscopic HRG is too general and fails to address the extra time and expense of equipment some procedures utilise. We found cost was very sensitive to length of operation. Delays and even teaching can make a ‘profitable operation’ lose money for the trust.

Payment by volume (not results)

Payment by results, a system for paying healthcare trusts, is intended as a fair and consistent basis for hospital funding. It relies on a national tariff structured around a case-mix measure known as healthcare resource groups. It is often argued that if payment by results works as planned, the National Health Service will become more efficient and productive. However, the use of a case-mix measure, the healthcare resource group, which derives from the diagnostic related (or diagnosis-related) group, has attendant problems. These include the risk that the payment structure will be inaccurate, unfair and liable to cause the financial destabilisation of trusts. There is also the risk that healthcare institutions will falsify patient classifications (‘up-coding’) to ensure higher remuneration. It has been argued that payment by results may be particularly unsuited to psychiatry. The ability of healthcare resource groups to accurately predict resource use in psychiatry is doubtful. In conclusion, mental health trusts will need to adapt to payment by results but there will inevitably be losers.