Clinician-directed improvement in the accuracy of hospital clinical coding

Abstract

Payment by results' (PbR) remuneration for healthcare services relies on the accurate conversion of diagnoses into Healthcare Resource Group (HRG) codes that are then reimbursed. Inconsistencies in documentation can result in inaccuracies in this process, with consequent implications for measuring activity, disease incidence and organisational performance. The aim of this study was to determine if clinician involvement increases accuracy in the coding of medical cases. Selected records of medical patients admitted to a London NHS trust between November and December 2016 were reviewed by a coding auditor and a clinician. Any changes to the codes and HRG tariff were noted. In total, 123 cases were considered. Changes in code were made on 68 instances, resulting in an overall increase in remuneration of £39,215; an average of £318 per patient. The primary HRG code was changed in 31 cases which accounted for £28,040 of the increase in tariff. In conclusion, clinician involvement can help with documentation ambiguities, thus improving the accuracy of the coding process in a medical setting. Although such collaborative working offers advantages for both the clinician and the coding team, further work is required to investigate the feasibility of this recommendation on a larger scale.

Effects of training on coding accuracy of obstetrical diagnosis in Naili DBS Hospital

“…Not only does the coding team benefit from the knowledge of the clinician, but the doctor also learns about the coding process, allowing them to improve their documentation appropriately in the future. 11 Another previous study from Joose, dkk showed that a dedicated course on injury coding using the AIS98 significantly improved the overall percentage of correctly coded injuries and correctly assigned injury severity at the Trauma Centre Brabant in the Netherlands. The learning effect of a course seems to last, as the results of this study showed improved performance scores until six weeks after the course.…”

“…This resulted in a higher remuneration equating to an increase of £318 per patient. 11 Other than good documentation; good communication and understanding between all health professions in the hospital also played a role in increasing the accuracy of the codes. In the hospital setting, the role of improving health and function is shared across all health professionals of the aim of successful discharge and reduced admissions.…”

“…Indeed, such benefits afforded by precise coding would survive any change in hospital financing away from a PbR system. 11 In a study conducted by Horsky, just over a half (56%) of all entered diagnostic codes were rated as appropriate and about one quarter were omitted. 15 The reasons behind this miscoding can be: first, the clinicians entering codes are not adequately trained to understand the requirements and nuances of the ICD 10 coding system.…”

Improving the quality of clinical coding and payments through student doctor–coder collaboration in a tertiary haematology department

“…6 10 11 However, there has been a focus on coder-coder and clinician-coder auditing, with some arguing that collaborative efforts should be led by senior clinicians as opposed to junior doctors. 6 We sought to establish whether medical student-led auditing could improve the accuracy of coding, thereby improving discharge summaries and generating income for the trust.…”

Enabling systems to support high quality end-of-life care

“…There is an example of a simple but elegant service redesign project to maintain equity of care, 7 educational initiatives to support the transition from medical student to foundation year doctors 8 and important lessons regarding clinical engagement in coding. 9 Early this year we will start to be listed on PubMed Central, which should also encourage those who want to ensure their research reaches the widest possible audience.…”