| Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit. | |
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MedLine Citation:
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PMID: 20210533 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework. |
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Authors:
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N Haliasos; K Rezajooi; K S O'neill; J Van Dellen; Anita Hudovsky; Sar Nouraei |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: British journal of neurosurgery Volume: 24 ISSN: 1360-046X ISO Abbreviation: Br J Neurosurg Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-09 Completed Date: 2010-08-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8800054 Medline TA: Br J Neurosurg Country: England |
Other Details:
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Languages: eng Pagination: 191-5 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Charing Cross Hospital, London, United Kingdom. nhaliasos@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Governance
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economics,
standards* Diagnosis-Related Groups / economics, standards* Great Britain Hospitals, Public / standards Interdisciplinary Communication Medical Audit / economics, standards* Neurosurgery / economics*, standards State Medicine / standards |
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