Abstract
Background: Increasing number of shoulder & elbow surgeries are performed arthroscopically. Accurate and ethical coding is challenging as it has become synonymous with reimbursement.
Aims & Objectives: To review the existing pattern of Coding for Shoulder & Elbow arthroscopy and ascertain its appropriateness/accuracy for surgical procedures & co-morbidities.
Materials & Methods: A retrospective study of all patients who underwent shoulder and elbow arthroscopies over four consecutive months was conducted. The excel sheet provided by coding department, Hospital notes – clinic letters, clinician’s entries, theatre notes & theatre lists – were reviewed. Of the 104 cases, 89 were available for analysis (75 shoulder & 14 elbow)
Results: The accuracy of primary procedural code was 91% though this fell to 71% when the entire description of performed surgery was considered. The procedural codes did not specifically reflect the surgery performed and lacked reproducibility. Co-morbidities were coded accurately in 57% of the patients. There were wide variations in coding for acromioplasty and distal end clavicle resections (12 instances) performed as a part of SAD. Biceps tenotomy/tenodesis often went uncoded (5 instances). The coding accuracy was low for shoulders as compared to the elbow.
Discussion: Coding is a universal language of communication amongst healthcare professionals. Its accuracy is important for data quality, audit and research. Genuine limitations of OPCS4.3 codes (esp. Shoulder eg. capsular release) exists which needs to be updated/amended to reflect advances in surgical practice. Reimbursement which is based on HRG codes are generated from OPCS4.3 (for surgeries) and ICD-10 codes (for co-morbidities) is less for arthroscopy as compared to open procedures in the NHS unlike in BUPA where it is equal.
Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE
