Abstract
Background
The viability of any surgical practice relies on the income that practice generates for the parent NHS Trust. The OPCS codes are a key determinant of an NHS trust's tariff for an admission. These contribute to the HRG codes - the means the NHS uses to determine the value of a patient's treatment, including operations. The clinical knowledge of coders may not differentiate specialist practice, including circular frames.
Methods
The OPCS and HRG codes generated by patient spells in one NHS trust were examined and reviewed retrospectively. The appropriateness of these codes were determined, and potential loss of income from inappropriate codes was calculated.
Results
There was a significant difference between the OPCS codes chosen by the coders and the surgeons. In six months, amongst 25 patients, there was a loss of income of nearly £200,000, due to incorrect coding and comorbidities.
Discussion
Coders do not have a clinical background and identify key phrases in an operation note and in patient stay that helps determine the OPCS codes. If these are not present, coders cannot presume a diagnosis or treatment. There is no homogeneity in the way that procedures are coded, and education is required to ensure that the appropriate codes are selected to generate the correct HRG tariff.
Conclusion
Significant loss of income can occur without engagement with the clinical coding department, which may affect the viability of a frame service.
