Title : Financial implications of undercoding in elective orthopaedic cases
Abstract:
Background: Medical diagnoses, procedures, patient comorbidity and social history are all used by coders to guide their coding. Clinical codes of varying value are generated on the basis of this information provided by clinicians. When this information is not communicated effectively to the coding department, it significantly impacts the financial remuneration hospitals receive. Coding systems influence hospital and departmental budgets, medico-legal documentation and strategic planning at local and national levels.This project highlights the difference accurate coding can make to departmental income.
Methods: We conducted a retrospective review of elective orthopaedic cases, which included minor to major procedures at North Middlesex University Hospital NHS Trust. The electronic clinical notes, discharge summaries, referral letters, operation notes and physical anaesthetic pre-assessment notes were analysed to collect data regarding procedures performed, co-morbidities, BMI, past medical history and social history. This information was communicated to the hospital’s coding team, who generated revised Healthcare Research Group codes. Differences in HRG tariffs were then calculated by comparing original and revised codes.
Results: A total of 144 elective orthopaedic cases were analysed. Of these, 74 cases were re- coded, resulting in a total income recovery of £76,000, averaging £528.00 income loss per case. Arthroplasty cases made up 68/144 and accounted for the greatest financial loss due to inaccurate coding. Only 6 cases were non-arthroplasty, contributing approximately £6,100 to income loss. Most discrepancies involved undercoding of comorbidity and BMI, which increased patient complication/comorbidity scores associated with increased remuneration.
Conclusions/Findings: The findings highlight the importance of effective communication between clinical and coding teams. Complication/comorbidity score and BMI information have a significant impact on financial remuneration of elective orthopaedic cases. This exercise was performed prior to financial year end and the findings remunerated to the Trust, thus enabling reinvestment into essential hospital services and improving patient care.
