Can an operative coding sticker improve coding accuracy and remuneration for upper tract stone-related procedures?

Abstract

Objective: Rigid ureteroscopy, flexible uretero-renoscopy and ureteric stenting are commonly performed procedures. Operative clinical coding and remuneration varies depending on the procedure. We determined if loss of remuneration, through poor operative coding, could be improved with an operative coding sticker. Patients and methods: We performed a retrospective review of 133 random stone-related procedures (rigid ureteroscopy/flexible uretero-renoscopy and ureteric stenting). Using the Office of Population Censuses and Surveys codes, we compared actual operative coding and urological surgeon coding. We introduced an operative coding sticker and prospectively re-audited to determine if coding accuracy improved. Results: Flexible uretero-renoscopy was initially miscoded in 29 of 53 cases (55%), with a loss of remuneration of £1014 per case. Rigid ureteroscopies were correctly coded in 99% of cases, but ureteric stenting was only correctly coded in 82%. The introduction of the coding sticker resulted in improved coding accuracy rates of 100% for rigid ureteroscopy, 95% for flexible uretero-renoscopy and 100% for ureteric stenting. Overall, coding accuracy improved from 54% to 99%. We estimate this coding sticker will improve our departmental remuneration by £67,938 per year. Conclusion: Rigid ureteroscopy, flexible uretero-renoscopy and ureteric stenting were initially poorly coded. The introduction of a simple operative coding sticker improved coding compliance to 99% and increased operative remuneration.

Trends in Upper Tract Stone Disease in England: Evidence from the Hospital Episodes Statistics Database

“…Reported data relate to finished consultant episodes (FCEs). Using the OPCS-4 procedural codes, we were able to identify all stone-related procedures [6][7][8][9][10] . Data collected included the following: age, demographics, location and nature of the procedures, emergency workload, length of stay (LoS) and procedural day-case rates.…”

“…In the past, criticism has been leveled at HES data in terms of its accuracy as it relies largely upon coding data, recorded from patient notes, by non-clinicians in NHS hospitals, at the time of patient discharge [5] . Furthermore, a recent paper that investigated the accuracy of clinical coding for upper tract URS found that up to 55% of the coding data can be erroneous, with the particular error of renal URS being coded as ureteric URS [6] . In spite of this, a recent systematic review demonstrated a median accuracy of 84.2% for recorded procedure data within the HES database [7] .…”

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

“…We have previously shown that ureteroscopy (URS) has been miscoded in over 50% of cases, mainly due to a lack of understanding from the coders about the procedure undertaken. 8 We previously introduced a URS coding sticker, and evaluated its role in coding accuracy and remuneration for URS.…”

“…4 Studies in urology and other surgical specialties have demonstrated considerable variation in coding accuracy with inevitable financial implications. [5][6][7][8] Reviews of coding errors have deemed these as multi-factorial in origin; however, a major determinant relates to clinical interpretation of notes. 9 To improve the accuracy of clinical coding in our hospital, an operative coding sticker for PCNL was designed which listed all potential components of PCNL ( Figure 1).…”