Introduction

The Exeter Hip femoral component remains largely unchanged from the original design, introduced in 1970. It is a highly polished, modular, double tapered stem and has undergone various minor modifications to surface, modularity and most recently the taper; changed to the current V40^TM design in 2000.

The effect of any design modification cannot easily be foreseen and greater emphasis is now placed on ensuring appropriate monitoring for such implants.

Introduction: In a climate of tightening budgets and rising cost the pressure on those performing complex and expensive surgery is ever increasing.

Patients requiring revision hip surgery are a particular burden on such limited resources.

Hospital trusts are dependent upon adequate remuneration for such complex procedures, a process reliant on accurate coding.

Methods: We performed a retrospective audit of our coding for revision hip surgery. This highlighted significant shortfalls in the coding process. We implemented necessary changes prior to a further prospective audit.

Results: The primary procedure was correctly coded in all our cases throughout, creating a standard tariff (mean £6,897).

However certain procedures enable an additional tariff uplift of up to 70%. Yet these additional procedures (performed in 81% of our procedures) had not been coded; loosing these additional tariff uplifts of 70%.

We involved and educated our coding staff, creating a ‘tick box’ sticker to be placed on every revision hip operation-record and completed by the operating surgeon.

Our subsequent tariff uplifts for these procedures have been significant.

Discussion: Joint replacement surgery is being performed in an ever younger and more active population. Patients are increasingly likely to outlive their prosthesis and peri-prosthetic fracture rates are set to continue rising.

In the modern NHS, surgeons must have a good understanding of complex tariffs. Coding staff are a notoriously poorly paid and undervalued component of any Hospital Trust, and invariably lack the surgical experience to interpret complex procedures.

Trusts must take measures to ensure such large tariff uplifts are not missed for complex procedures.

We explain the tariff process and discuss how improvements can easily be achieved by individual trusts.