Abstract
Introduction
We conducted an audit on hip fractures to analyse the accuracy of coding and payment by results in our institution.
Materials/Methods
The initial audits analysed hip fracture over a period of four months at two different trusts. Case notes were reviewed to extract data regarding diagnosis, comorbidities and operative procedures. The findings were compared with the data from clinical coding department and difference in the tariff was analysed. A re-audit was performed at Trust B after implementation of changes to assess improvement.
Results
In the initial audit 111 patients were reviewed. Twenty-three percent patients had all data correctly coded. In the remaining 77%, some of the co-morbidities had been missed, e.g. UTI, anaemia and osteoporosis etc. 11.7% of operative procedures and 16.5% of fracture patterns were incorrectly coded resulting in loss of £53 000 over the 4 month period. Poor documentation and the use of ‘uncodable’ language by clinicians were responsible for missing co-morbidities, while inadequate medical knowledge of clinical coders resulted in the incorrect recording of operative procedures. We implemented changes in the form of clinical coders training, awareness of “codable words” by medical staff and writing the procedure codes by the surgeons themselves. A re-audit at Trust B showed an estimated savings of £18540.00 over 3 months period, demonstrating a significant improvement.
Conclusion
Inaccuracies in clinical coding result in loss of tariff. Awareness of codable words, writing the operative codes by surgeons and training of clinical coders can improve clinical coding and payment by results in NHS hospitals.
