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Interventional procedures: physician involvement enhances clinical coding

Andrew Medford
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DOI: https://doi.org/10.7861/clinmedicine.12-4-396
Clin Med August 2012
Andrew Medford
North Bristol Lung Centre, Southmead Hospital, North Bristol Hospitals NHS Trust, Westbury-on-Trym
Roles: Consultant physician and honorary senior clinical lecturer in thoracic medicine
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Editor – The study by Hogarth et al (Clin Med April 2012 pp189) demonstrates marked improvement in coding and financial outcomes by better collaboration between clinicians and coders in the setting of electrophysiology and device procedures.1 This is also generalisable to other interventional procedures, particularly as they tend to attract higher tariff and are typically performed in high volume as they generally require expertise in particular centres with sufficient patient flow, and hence the potential for financial disparity if these are miscoded is much higher. The principal requirement for success here is for better collaboration between clinicians and coders, although this can be achieved in different ways.

Indeed there is an unmet need for this, as the Audit Commission has noted that coding inaccuracies seem to be particularly prevalent in interventional specialties with significant national variation between 0.3% and 52% across acute trusts in England.2 In the field of interventional pulmonology, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is performed in high volume in a number of centres. EBUS-TBNA attracts a far higher specific tariff than conventional fibreoptic bronchoscopy: nearly seven times more (£3404 (E63.2 + T87.4) versus £504 respectively).3

We (as well as the Audit Commission) have also previously demonstrated significant inaccuracies in coding in the field of interventional pulmonology, with >15% coding inaccuracy in a single centre for EBUS-TBNA and >68% inaccuracy for local anaesthetic thoracoscopy, with estimated financial discrepancies of at least £65,000 for one procedure in one centre annually.4,5 We have managed to prevent all EBUS-TBNA coding errors by electronically notifying all procedures anonymously to a key member of the coding team after each procedure session, verified by independent cross-checking of the tariff applied and a monthly checklist from the coding team.6 This has now resulted in estimated savings of £78,000 for the last 165 EBUS-TBNA procedures (projected from the original error rate and cost saving).

In summary, small changes in collaborative behaviour between clinicians and coders in interventional specialties have the potential to make large cost savings even for one procedure alone, and can reduce financial disparity and are worthy of consideration. We therefore endorse the intervention by Hogarth et al and suggest this may be of particular relevance to other interventional specialties.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2012 Royal College of Physicians

References

  1. ↵
    1. Hogarth A,
    2. Tayebjee M,
    3. Lee G,
    4. et al
    . Clinical coding for electrophysiology and device procedures: why and how to do it. Clin Med 2012;12:189.
    OpenUrlFREE Full Text
  2. ↵
    Audit Commission. PbR Data Assurance Framework 2007/08: findings from the first year of the national clinical coding audit programme. Audit Commission: London, 2008. http://www.audit-commission.gov.uk/SiteCollectionDocuments/AuditCommissionReports/NationalStudies/PbRreport.pdf [Accessed 29 June 2012].
  3. ↵
    Department of Health. Confirmation of Payment by Results arrangements for 2010/11. London: DH, 2010. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_112284 [Accessed 29 June 2012].
  4. ↵
    1. Medford AR,
    2. Agrawal S,
    3. Free CM,
    4. et al
    . A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM 2009;102:859–64.doi:10.1093/qjmed/hcp136
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Medford AR,
    2. Agrawal S,
    3. Free CM,
    4. et al
    . Retrospective analysis of Healthcare Resource Group coding allocation for local anaesthetic video-assisted ‘medical’ thoracoscopy in a UK tertiary respiratory centre. QJM 2009;102:329–33.doi:10.1093/qjmed/hcp016
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Medford ARL,
    2. Pillai A
    . Does greater physician involvement with interventional procedure coding improve coding outcome? Thorax 2011;66(Suppl IV):A143-4[P187].doi:10.1136/thoraxjnl-2011-201054c.187
    OpenUrlCrossRef
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Interventional procedures: physician involvement enhances clinical coding
Andrew Medford
Clinical Medicine Aug 2012, 12 (4) 396; DOI: 10.7861/clinmedicine.12-4-396

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Interventional procedures: physician involvement enhances clinical coding
Andrew Medford
Clinical Medicine Aug 2012, 12 (4) 396; DOI: 10.7861/clinmedicine.12-4-396
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