Introduction: Ever since the coding has been introduced in the NHS there has been lot of debate whether the trust is being paid accurately. There is no data available which compares the coding done by the surgeon and the one done by the coding department.

Material and Methods: A prospective study was done on 305 patients in an elective orthopedic hospital over a period of one month. All operations were coded separately by the operating surgeon and the coding department. The procedures included all upper and lower limb procedures other than elective hand, spine and paediatric procedures. The results were compared by an independent assessor in line with the national guidelines and the information originally available to clinical coders.

Results: The results showed a marked difference in reimbursement cost of complex procedures, revisions and co-morbidities as coded by the surgeon who took into consideration additional top ups which were available and these were often missed by the coding department. There was no difference in the primary hip and knee arthroplasty.

Conclusion: There is an increased need for correct coding as this can result in potential income consequences by applied tariffs. With the introduction of acute phase tariffs and marked difference in reimbursement to the trust if correct codes are not applied, there is an increased need for awareness for the coding and the top-ups available for complex procedures.

Background: Increasing number of shoulder & elbow surgeries are performed arthroscopically. Accurate and ethical coding is challenging as it has become synonymous with reimbursement.

Aims & Objectives: To review the existing pattern of Coding for Shoulder & Elbow arthroscopy and ascertain its appropriateness/accuracy for surgical procedures & co-morbidities.

Materials & Methods: A retrospective study of all patients who underwent shoulder and elbow arthroscopies over four consecutive months was conducted. The excel sheet provided by coding department, Hospital notes – clinic letters, clinician’s entries, theatre notes & theatre lists – were reviewed. Of the 104 cases, 89 were available for analysis (75 shoulder & 14 elbow)

Results: The accuracy of primary procedural code was 91% though this fell to 71% when the entire description of performed surgery was considered. The procedural codes did not specifically reflect the surgery performed and lacked reproducibility. Co-morbidities were coded accurately in 57% of the patients. There were wide variations in coding for acromioplasty and distal end clavicle resections (12 instances) performed as a part of SAD. Biceps tenotomy/tenodesis often went uncoded (5 instances). The coding accuracy was low for shoulders as compared to the elbow.

Discussion: Coding is a universal language of communication amongst healthcare professionals. Its accuracy is important for data quality, audit and research. Genuine limitations of OPCS4.3 codes (esp. Shoulder eg. capsular release) exists which needs to be updated/amended to reflect advances in surgical practice. Reimbursement which is based on HRG codes are generated from OPCS4.3 (for surgeries) and ICD-10 codes (for co-morbidities) is less for arthroscopy as compared to open procedures in the NHS unlike in BUPA where it is equal.

Introduction: Accurate and ethical coding is challenging and directly impacts on Payment by Results (PbR). The aims & objectives of this study were to review the existing pattern of coding for spinal surgery and ascertain its appropriateness & accuracy for surgical procedures, medical co-morbidities and post-op complications.

Methods: A retrospective review of 70 consecutive cervical and 100 consecutive lumbar spine patients who were operated from April 2006 onwards was conducted. The excel sheet provided by coding department, hospital notes – clinic letters, physicians’ entries, theatre notes and laboratory reports (biochemistry/microbiology/histology) – were reviewed. Of the 170 cases, 165 were available for analysis.

Results: Coding data of 5 patients who underwent cervical spine surgeries were not available. Of the 165 cases, the accuracy of primary procedural codes was 93.9% (90.8% cervical & 96% lumbar). However this reduced to 77.6% (75.4% cervical & 79% lumbar) when the accuracy for entire description of performed surgery was considered. The procedural codes did not specifically reflect the surgery performed and lacked reproducibility. Surgical levels were coded incorrectly in 9% of the cases. Cervical surgeries were coded as lumbar in 4 and posterior surgery as anterior in 3 cases respectively. Harvest of iliac crest bone graft was not coded in 5 cases. Medical comorbidities were coded appropriately in 64.2% of the patients (55% cervical & 70% lumbar). The commonly missed comorbidities were drug allergies, hypercholesterolemia, smoking and alcoholism. Post-op adverse events were coded in 75% of the cases (16/20 cervical & 5/8 lumbar). The accuracy was better for lumbar as compared to cervical spinal surgeries.

Conclusion: Coding is a universal language of communication amongst healthcare professionals. Its accuracy is important not just for PbR, but for data quality, audit and research purposes too. The financial implications regarding PbR governed by HRG codes (dictated by OPCS 4.4 & ICD–10 codes) are discussed. The awareness of clinical coding is low amongst junior doctors. Following this study, a clinical coding facilitation form has been introduced to improve data quality. Our plan is to close the audit loop and re-evaluate. Literature emphasises qualification of coders, legible documentation by physicians and interaction between coders and clinicians.