Abstract
Purpose
Clinical coding is used to record information from patient admissions in the form of coded data used for monitoring the provision of health services and trends, research, audit and NHS financial planning.
Method
A sample of 105 cases admitted to Southampton General paediatric orthopaedic department from 2006-9 was used. 31 admissions were grouped using HRG4 and the remaining 74 using HRG3.5. Accuracy of coding was calculated by establishing correct discharge coding and comparing them with coding records. The correct codes were run through HRG 3.5 and 4 payment groupers and their outcomes were compared financially to the HRG codes these admissions were actually grouped under.
Results
There were 800 interventions which should have been coded over 148 patient episodes. Of these 442 (55%) were not coded, 189 (24%) were coded inappropriately and 169 (21%) were coded correctly.
The HRG3.5 group was coded 18% correctly, the HRG4 29% correctly. However, 70% of the HRG4 and 49% of the HRG 3.5 group were inaccurately grouped. The resulting deficit was a £54,352 (HRG4-£36,711, HRG3.5-£17,641) an average of £507 per patient stay. A conservative estimate of 150 ward admissions monthly means a projected loss of £912,600 per annum.
The fractured radius and ulna group (one of the most common causes of admission) suffered greatest financial losses.
Additional losses come from paediatric/orthopaedic top-ups (63% and 14% respectively) as only one can be applied to each HRG.
Conclusion
The implementation of HRG4 means accuracy is crucial as smaller inaccuracies result in bigger costing discrepancies than with HRG 3.5. Financial losses are larger with paediatric orthopaedics from inadequate top-ups.
This system of Payment by Estimates not Results is only acceptable if financial underestimates are balanced with financial overestimates. These results strongly suggest this is not happening.
