Hello, fellow healthcare enthusiasts! Today we are going to dive into our favorite subject, clinical coding. Are you aware of its impact on hospital funding, disease tracking, and overall performance metrics? Well, you’re about to find out!

The Coding Quandary

‘Payment by Results’ (PbR) is a common healthcare reimbursement system where diagnoses are translated into classification codes, and then grouped into Healthcare Resource Group (HRG) codes for billing. However, inaccurate documentation can lead to coding errors, potentially affecting revenue and data quality. This got a team of researchers led by Krsna Mahbubani thinking – could clinician involvement improve coding accuracy?

The Experiment

The researchers tested this idea by examining selected medical records from a London NHS trust between November and December 2016. A coding auditor and a clinician reviewed these records, noting any changes made to the codes and HRG tariffs.

Unveiling the Results

In total, 123 cases were reviewed. The findings were pretty enlightening! Changes in codes were made on 68 occasions, leading to an overall increase in remuneration of £39,215; an average boost of £318 per patient. The primary HRG code was altered in 31 cases, which contributed to £28,040 of the tariff increase.

Breaking Down the Implications

This study shows us that clinician involvement can play a pivotal role in reducing documentation ambiguities and consequently, enhance the accuracy of the coding process in a medical setting. Better coding not only improves the financial health of medical institutions but also ensures more accurate tracking of disease incidence and healthcare services.

The Path Ahead

While the benefits of clinician involvement are clear, this collaboration might require some tweaking to be feasible on a larger scale. It’s time for healthcare institutions to consider integrating clinicians into the coding process and conduct more extensive research to find the best way to implement this valuable practice.

So, whether you’re a clinician, a clinical coder, or a healthcare enthusiast, it’s fascinating to understand how meticulous coding can have a ripple effect, touching various aspects of healthcare delivery. And remember, accurate coding is a team sport, and every player matters! Until next time, keep your curiosity piqued for more exciting insights from the healthcare world!

Sources:

Mahbubani K, Georgiades F, Goh EL, Chidambaram S, Sivakumaran P, Rawson T, Ray S, Hudovsky A, Gill D. Clinician-directed improvement in the accuracy of hospital clinical coding. Future Healthc J. 2018 Feb;5(1):47-51. doi: 10.7861/futurehosp.5-1-47. PMID: 31098532; PMCID: PMC6510043.