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Clinical Coding

Clinical Coding. Mr Buddhi Pant Deputy General Manager Children’s Services SGUHT. Across England, NHS organisations are facing the challenge of delivering their commitments under the NHS Outcomes Framework within current financial constraints.

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Clinical Coding

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  1. Clinical Coding Mr Buddhi Pant Deputy General Manager Children’s Services SGUHT

  2. Across England, NHS organisations are facing the challenge of delivering their commitments under the NHS Outcomes Framework within current financial constraints. • Finance managers have a critical role to play in this challenge but they cannot deliver it alone. It is clinicians – doctors, nurses and allied health professionals – who commit NHS resources and who need a greater understanding of the financial consequences of their actions. • In this context, many questions have been raised in the NHS. Not least, what do clinical and financial professionals need to be able to develop more productive partnerships? What are the barriers which the NHS needs to overcome, the key levers for engagement and the best practice steps for a way forward? Presentation title / St George’s University Hospitals NHS Foundation Trust

  3. Background • Clinical coding is the translation of medical terminology, as written by the clinician, to describe a patient’s complaint, problem, diagnosis, treatment or reason for seeking medical attention, into a coded format’ which is nationally and internationally recognised. • It is used for epidemiological and statistical purposes, as well as to determine service provision. It is also used to ensure each health care trust is paid accurately for its clinical activity by a system of Payment By Results. Presentation title / St George’s University Hospitals NHS Foundation Trust - Mr Buddi Pant

  4. Main Classifications • ICD-10 • International • Used to capture diagnostic clinical data • OPCS-4 • UK specific • Used to capture surgical interventions & procedures

  5. There is evidence that the understanding of clinical coding and indeed the background to this, structure and finances of the NHS amongst clinicians, in particular, junior doctors, is extremely poor (O’Dowd, 2013). For clinical coding to improve, clinicians must understand the significance of clinical coding and why in the current climate, it is absolutely crucial that improvements are made. Presentation title / St George’s University Hospitals NHS Foundation Trust

  6. Payment Process • The NHS payment regime for admitted patients (Inpatients, Daycases, Maternity, Emergency admissions) is 100% based on the clinical coding - if the coding doesn't fully reflect the patients stay they hospital won't receive the correct amount of money to cover what they did for the patient - hence pressure on coders to be as detailed and specific as possible with the coding. (the clinical codes are put through something called an HRG grouper that determines the £price) . Presentation title / St George’s University Hospitals NHS Foundation Trust

  7. Deadlines • These days quite a lot of time (in a good coding dept) is taken up on clinical engagement, explaining to Drs (and Medical students) what information they should ensure is written in the notes and then how what they write is translated into codes for clinical coding purposesThere are also strict deadlines to get coding done by (about 6 weeks after the patient is discharged - if that is missed the Hospital doesn't receive any money for the stay. Presentation title / St George’s University Hospitals NHS Foundation Trust

  8. Coding for Clinicians • Coding for clinicians • Clinicians and coders are a team united in ensuring that the record of patient care is accurate and timely. • Clinicians can support their coders by: • writing clearly in the patient notes • including all the relevant information • make time for communication with coders to explain any patient care in the notes • Together they clinician and coder can improve the quality of the patient data and so improve planning for care. Presentation title / St George’s University Hospitals NHS Foundation Trust

  9. Accuracy is reliant upon… • The Clinician providing the information on the patient’s diagnoses and treatment • The Clinical Coder translating that information into the appropriate coded format to reflect the patient’s hospital stay

  10. Accurate and Complete Information • Complete diagnostic and procedural information is vital. • Hepatitis K75.9 Inflammatory liver disease, unspecified • Acute Hepatitis K72.0 Acute and subacute hepatic failure • Alcoholic Hepatitis K70.1 Alcoholic Hepatitis • the coding accuracy is dependent upon two sets of staff. • The clinical side – providing the information • The coding side – translating the medical terminology

  11. Chest Pain ?MI Abdominal pain - possibly cholecystitis, possibly appendicitis Chest pain investigations confirmed MI Abdominal pain treated as appendicitis Possible and ? Diagnoses • Clinical Coding staff can only code fact. They cannot make assumptions on diagnoses or treatments. The source document must therefore clearly state diagnoses and treatments. • Coders are trained to interpret words as follows •         Possible/?: Code the presenting 'symptom, abnormal finding or problem'  •         Probable / Presumed/ Treat As: Seek advice of the clinician or code as a firm diagnoses. clinicians should be aware that their words are interpreted in this way.

  12. Clinicians and Data Quality • The source documentation should: • Be accurate and complete • Reflect the patient’s episode of care • Avoid the use of abbreviations • Be clear and detailed • Recording is legible and in indelible ink • Include comordities / complications /

  13. Clinical Statistical Uses of Clinical Coded Data Treatment effectiveness Clinical Governance Outcome measurement Clinical audit Cost analysis Health trends Commissioning Financial flows Epidemiological studies Aetiology studies Clinical Indicators Casemix planning

  14. Florence Nightingale 1863 • "I am fain to sum up with an urgent appeal for adopting … some uniform system of publishing the statistical records of hospitals. There is a growing conviction that in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life … In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison … If wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have means of ascertaining at present?" Florence Nightingale in Notes on Hospitals, London: Longman, Green, Roberts,Longman, and Green, 1863.

  15. How does the code Translate into HRGs (Money)

  16. With out / With CC

  17. Top 15 Profit Making HRG by activity

  18. Top 15 Loss making HRGs – Paed Medicine

  19. Useful links • http://apps.who.int/classifications/icd10/browse/2010/en Presentation title / St George’s University Hospitals NHS Foundation Trust

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