Why coding MATTERS for non-coders

Coded clinical data (generated from classifications OPCS-4 and ICD-10) uses rules and conventions that, when applied accurately result in the provision of high quality statistically meaningful data.

This directly affects:

• Clinicians and all healthcare professionals – as the coders now record in greater detail the activity in trust.
• Financial teams – as the coded clinical data is grouped to meet the reporting structure of Payment by Results to ensure the trusts are paid accurately for activity.
• Information managers and data analysts – to support service planning and delivery decisions
• IT professionals – as the execution of the national programme for IT and improved classifications requires their collaborative working with clinicians and coders to effectively implement necessary system upgrades.

The NHS requires input of accurate data to reflect clinical activity and trusts now have a financial incentive to ensure that coding is accurate, comprehensive and timely.

The introduction of Payment by Results means that all English trusts will use a fixed price tariff for specific treatments. At the heart of this is coded clinical information provided by clinical coders. Trusts will have to ensure that their coding is accurate – or errors will impact on their income. Unless trusts take actions to ensure coding is accurate the adage 'rubbish in - rubbish out' is a harsh reality.

Counting the costs

Incomplete coding

I21.1 (ICD 10) Acute transmural myocardial infarction of
inferior wall
V3.5 HRG E12 Acute Myocardial Infarction w/o cc
Ref Costs 2005-06 Non Elective In Patient = £1,169

Complete coding

I21.1 (ICD 10) Acute transmural myocardial infarction
of inferior wall
K60.1 (OPCS) Implantation of intravenous cardiac
pacemaker system
Y70.5 (OPCS) Temporary operations
V3.5 HRG E07 Pacemeaker Implant for AMI, Heart
Failure or Shock
Ref Costs 2005-06 Non Elective In Patient = £4,336

The Audit Commission provides more information which highlights the impact that incomplete information can make to how your trust will be funded.

How coding counts

Accurate coding makes a difference and the key is:

• adherence to standards,
• investment in training and
• regular audit.

The regular clinical coding audit provides users with the necessary information to achieve continuous quality improvement resulting in a robust data quality cycle.

The Code of Practice for auditors has been endorsed by the Audit Commission stating "it puts robust safeguards into the audit process to preserve impartiality".

Support from the NHS Classifications Service

The service is based in NHS Connecting for Health as an expert national classification centre with authority to deliver and uphold national classification standards.

Our products and services include:

• Clinical classifications Helpdesk Service supporting the national clinical coding query mechanism.
• ICD-10 and OPCS-4 files and supporting tools such as metadata files
• National standard clinical coding reference materials
• UK Coding Review Panel providing guidance and developing national clinical coding standards
• National Clinical Coding Qualification (UK) and associated materials
• Clinical coding audit methodology, Code of Practice and workshops
• Clinical classifications training service – a portfolio of courses and training materials to support coders and trainers

A presentation on coding for non coders made at a recent conference is available for download