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

Nouraei, S.A.R.; Hudovsky, A.; Virk, Jagdeep Singh; Chatrath, Paul; Sandhu, Gurpreet S.

doi:10.1111/coa.12153

Cited by 16 publications

(31 citation statements)

References 7 publications

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“…A coder, however, would look through the clinical records and look for the condition being documented by the clinical team. We have previously shown that the particular subset of diagnoses where the diagnosis can be inferred from numerical results are subject to significant subjectivity, variability and error as clinical coders cannot infer a diagnosis from numbers alone . It is possible to produce local and national coding policies to enable the coders to equate post‐treatment blood calcium levels with the diagnosis of Post‐procedural Hypoparathyroidism (E892).…”

Section: Discussionmentioning

confidence: 99%

A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery

Nouraei

Virk

Middleton

et al. 2016

Clinical Otolaryngology

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Objectives: Thyroid conditions are common and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity are central to improving patient care. Accepted ArticleThis article is protected by copyright. All rights reserved. Results: Mean age at surgery was 49±30 and a female predominance (82%) was observed.Most patients underwent hemithyroidectomy (51%) or total thyroidectomy (32%). Patients underwent surgery for benign (52.5%), benign inflammatory (21%), and malignant (17%) thyroid diseases. Thyroid surgery grew by 2.9% a year and increased in specialization.Increased surgeon volume significantly reduced lengths of stay: the proportion of length of stay outliers fell from 11.8% for patients of occasional thyroidectomists (<5 per year) to 2.8% for patients of high-volume surgeons (>50 thyroidectomies a year). Post-discharge vocal palsy and hypocalcaemia occurred in 1.87% and 1.58% of cases respectively. High-volume surgeons had a reduced incidence of vocal palsy and volumes >30 were consistently protective.Conclusions: Thyroid surgery is increasingly specialised. High-volume surgeons achieve lower complications rates, including lower vocal palsy rates, and length of stay.

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Section: Discussionmentioning

confidence: 99%

A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery

Nouraei

Virk

Middleton

et al. 2016

Clinical Otolaryngology

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“…Haliasos et al [3] found at least one coding error in 18.4% of neurosurgical cases, and HRG changes in 10.4%, with a loss of £111 per patient episode. In Nouraei et al [13], their ENT coding audit led to at least one change of coding in 44% of cases, and to HRG changes in 16%, with an income variance of £109.46 per patient. In Naran et al [14], their audit led to at least one change of coding in 77% patients, and to HRG code changes in 54% patients, with an estimated £114 in lost revenue per patient.…”

Section: Comparison With Literaturementioning

confidence: 99%

Clinical coding and data quality in oculoplastic procedures

Juniat

Athwal

Khandwala

2019

Eye

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Introduction Hospitals in England are reimbursed via national tariffs set out by NHS England. The tariffs payable to hospitals are determined by the activity coded for each patient's hospital visit. There are no national standards or publications within oculoplastics for coding accuracy. Our audit aimed to determine the accuracy of coding oculoplastic procedures carried out in theatres and to assess the financial implications of any discrepancies. Methods We carried out a prospective audit of consecutive oculoplastic procedures performed at one hospital site over a 6-week period. We subsequently created a coding proforma and performed a re-audit using the same methods. Results In the first cycle, clinical coding was 'correct' in 30.7% of cases, 'incomplete' for 12.9% and 'incorrect' for 56.5%. Of the 'incorrect' codes, 54.3% were coded as non-oculoplastic procedures (e.g. extraocular muscle surgery). We discussed our findings with the coding team in order to address the sources of error. We also created a 'tick box' coding proforma, for completion by surgeons. Our re-audit results showed an improvement of 'correct' coding to 85.7%. Conclusion Clinical coding is complex and vulnerable to inaccuracy. Our audit showed a high rate of coding error, which improved following collaboration with our coding team to address the sources of error and by creating a coding proforma to improve accuracy. Accurate clinical coding has financial implications for hospital trusts and consequently Clinical Commissioning Groups. In times of severe financial pressures, this could be a valuable tool, if rolled out over all specialities, to make much needed savings.

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“…Otolaryngology (ENT) is comparable to HPB in terms of the complexity and subtle differences between the procedures performed. Studies on coding accuracy in ENT have reported similar high levels of coding error with nearly a quarter of cases having coding inaccuracies with over half of these resulting in reduced tariffs . Results from these data suggest that it may be beneficial for coding departments to be specialty based and each department is assigned its own coder.…”

Section: Discussionmentioning

confidence: 83%

Coding in surgery: impact of a specialized coding proforma in hepato‐pancreato‐biliary surgery

Murphy

May

Carlo

et al. 2017

ANZ Journal of Surgery

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

Abstract: 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.

Cited by 16 publications

References 7 publications

A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery

A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery

Clinical coding and data quality in oculoplastic procedures

Coding in surgery: impact of a specialized coding proforma in hepato‐pancreato‐biliary surgery

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