Abstract
Introduction: Coding systems are important for epidemiology, research, audit, activity analysis and now remuneration. There have been concerns that the existing coding systems do not represent foot and ankle activity accurately.
Materials and Methods: The senior author’s logbook was analysed for 2 years. Each operation descriptor was recorded. A “simple descriptor” described an operation of one component (“scarf osteotomy”). A “multiple descriptor” described multiple instances of one component (“bilateral scarf osteotomy”). A “compound descriptor” described a procedure made up of more than one component (“scarf osteotomy and 2nd toe straightening”). We encoded the logbook using OPCS4.5 and the RCSED Electronic Logbook. We assessed whether simple descriptors could be coded unambiguously (ie there was a one-to-one relationship between descriptor and code so that distinct procedures could be identified) and whether compound descriptors contained ambiguous codes. We also considered whether the overall procedure was adequately summarised by the tabulated codes. Codes were converted to the HRG4 and BUPA payment codes and referenced to chevron osteotomy.
Results: There were 513 procedures with 157 different descriptors (3.27 cases/descriptor, compared with 4.44 in upper limb and 7.69 in lower limb). Fifty-four descriptors (321 patients) were simple, 18 (52 patients) were multiple and 85 (140 patients) were compound. Using OPCS, 57.4% of simple descriptors (46.1% of patients) were ambiguous, as were 82.4% of compound descriptors (85.7% of patients). In 27.1% of descriptors (33.6% of patients) the tabulated codes did not give the overall procedure clearly. Using the eLogbook, 48.1% of simple descriptors (25.2% of patients) and 74.1% of complex descriptors (70.7% of patients) were ambiguous and in 30.6% of descriptors (37.1% of patients) the codes did not summarise the operation well. Most remuneration compared reasonably with chevron osteotomy, with some idiosyncrasies. Overall remuneration was lower than procedures of comparable complexity in other specialties.
Correspondence should be addressed to: Mr Andrew H. N. Robinson, Editorial Secretary, Department of Trauma and Orthopaedics, BOX 37, Addenbrooke’s Hospital, Cambridge CB2 2QQ, England.
