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What I wish I knew before I went into Clinical Coding

By Jonathan France ACC
Perception of the Role

It’s surprising to me how many people both within and outside of hospital see this as a purely admin or data input role. It’s so much more than that. Coding has such a unique skill set that incorporates facets such as analytics, attention to detail and the odd bit of detective work. These few skills alone make the role way more specialised than most people think.

Importance of the role

Pre block contracts coding was the main source of securing finance through payments by results (PbR). The very codes you selected would have a direct correlation on the HRG & tariff mapping. You speak to anyone in NHS finance and they’ll tell you that the most important people within the trust aren’t the doctors and nurses (who do an amazing job in their own ways) but the clinical coders. Without them the trust wouldn’t exist or be self-sustaining. Since block contracts the importance around coding has somewhat diminished as PbR is all but extinct, but coding still has an important role to play in SUS data and healthcare planning.

Disparity in Pay
One for the purists this, but having spent a good 4 years outside of the NHS working for a healthcare disruptor it always mazes me the number of coding positions out there ranging from a band 2 to a band 6 (for both ACC and non ACC) and the disparity in the pay for these positions. I’ve seen neighbouring trusts (outside of London) have different pay scales and training programmes and the trust that pays better (trust A) attract all the staff from the neighbouring trust (Trust B). Trust B then has a shortage in staff, can’t recruit and then has draft contractors in at a substantially higher rate than a coders salary. It’s such a vicious circle. You’d think that trusts would work together to stop this kind of thing happening. But then again I thought Agenda for Change (AfC) was brought in to be equal and fair for everyone?

You’re never a know it all
As someone who’s been around the block a few times, experienced all NHS, private and independent sectors it’s easy to assume that you’ve been there, done that and know everything there is to know about coding (with a few harsh lessons thrown in). You’d be wrong. Just when you think you’ve cracked it a coding standard will change, or a new code is introduced or sequencing is now flexible (think dagger & asterix – main condition treated) and you had to effectively re-learn what came before. But this is one of the great things about coding. You’re always learning, always thinking and always humble.

The pessimism around the ACC
This is one I’m quite passionate about…
Having spent a good majority of time in the contract market (and recently gone back) you pick up on certain things. One of these is the pessimism around the ACC qualification. I used to hear all the time (from managers too) ‘Just because your ACC qualified doesn’t mean you’re a good coder’. Whilst I sympathise with those managers that have been unlucky enough to witness those ACC qualified contractors that aren’t up to scratch, I’m pleased to say that those contractors are in the minority.
Surely, we should be celebrating the ACC qualification. It is after all an industry recognised qualification. A benchmark to show where a coder is at. It’s not like these are handed out willingly. It takes time and years of dedication, commitment and sacrifice to be at a level to even attempt to sit the exam. So, whilst some contractors may’ve let themselves down with their coding, we shouldn’t detract from the fact that they do have some coding skills and knowledge as their ACC certified. If you’re not a good coder, you don’t pass the exam. After all…. if it was that easy to pass, they we’d all pass first go.

And Lastly…
How unknown the role is?

We’ve all been there at a party or social gathering (socially distanced I hope) and someone says ‘So (insert name here) What do you do?’. You then proceed to tell them what you do, and you get the same blank expression as I get. You then delve into a bit more detail about the role. They’re still none the wiser. Same blank look? Yep?. Now I just tell people to ‘Google it’. More often than not they seem impressed.


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January 1, 2021

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