Background The Royal College of Physicians of London Health Informatics Unit has developed the Professional Record Keeping Standards. Trusts have a financial incentive to code activity accurately under Payment by Results. Coding inaccuracy is well described by the Audit Commission varying from 0.3% to 52% across Acute Trusts in England, with the potential for gross financial disparity, with particular inaccuracy in interventional specialties.1 We have previously noted a 14.6% coding inaccuracy rate for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).2 Given that the specific EBUS-TBNA tariff is approximately six times the conventional bronchoscopy tariff, EBUS-TBNA is a good model to illustrate the potential financial effects.
Hypothesis Greater physician involvement with a prospective coding cross-checking system would improve coding outcome for EBUS-TBNA and financial disparity.
Methods From November 2010 to June 2011, 52 consecutive patients underwent EBUS-TBNA in a UK teaching hospital. After every procedure, anonymised patient details were emailed securely to the Trust Coding Lead. Every month, the Trust Informatics Lead would email the final coding outcomes and tariffs for all the EBUS-TBNA patients. These were cross-checked against a prospective anonymised procedure database. Primary outcome was coding accuracy. Data were compared to a previous EBUS-TBNA coding study2 as a control (no coding intervention) using contingency table analysis with Fishers Exact Test and a p value of <0.05 was deemed significant (GraphPad Prism 5 software). Differences in financial loss were calculated using a tariff of £504 for conventional bronchoscopy and £3404 for EBUS-TBNA (E63.2+T87.4).
Results All 52 patients were coded correctly with no financial loss. From the previous study of 52 patients, 8 (14.4%) were coded incorrectly which was significant (OR 20.1, 1.1–357.5, p=0.006, Fishers Exact). Financial loss to the NHS Trust was calculated as £23 200, projected to £40 000 per year.
Conclusion Greater physician engagement with coders improves coding outcomes. This is of particular importance in interventional specialties where the potential for financial loss is of a higher magnitude. A simple prospective cross-checking system can achieve better outcomes with no extra cost and minimal effort.
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