Abstract
Introduction: The HRG 4 coding system was introduced in April 2009 to allow the calculation of tariffs for all surgical procedures. At our institution we felt surgeon input could improve the accuracy of this coding and optimise trust income.
Method: A retrospective audit of one month’s procedures under the care of a single consultant was performed. The hospitals coding and tariff, as performed by coding clerks, was reviewed and the procedures were re-coded by a foot and ankle fellow using the notes and the HRG 4 grouper. A comparison was made between the coding and income generated in the standard fashion and that achieved after optimisation by surgeon input.
Results: The codes of 51 patients were examined. 86% of major foot procedures were correctly coded. However, 56% of ‘minor’ procedures were recoded as ‘intermediate’, many of these involving hallux valgus surgery. 58% of procedures had a different code after surgeon input and 41% generated a different tariff. The total tariff for the coding clerk group was £79,192. The total tariff in the surgeon assessed group was £97,268 - a difference of £18,076. Extrapolated over the year this could represent a potential gain of over £200,000, for a single Consultant in a single Trust.
Conclusion: We believe surgeon involvement in coding is crucial to improve accuracy and to optimise trust income. We will discuss various issues surrounding the new HRG 4 codes and how best to use them in current practice.
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.
