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■■provide training to the coders covering how skin procedures should becoded, as these can be coded in two ways depending on the site of thebody that has been operated on. The coder had not reflected thedifferent site of procedures within the codes allocated and continued touse only codes from chapter ‘S’ when sometimes the correct codesshould be from other specific chapters. For example skin operation onthe ear should be coded using a code from chapter ‘D’ with a code fromchapter ‘S’ to enhance this. All coders must have this rule re-enforced toensure these are coded correctly; andreinforcing the importance of recording the mandatory co-morbiditiesfrom the March 2010 Coding Clinic, as omission of secondarydiagnoses was an issue from both the coder and clinical perspective.84 There were eight non-coder errors due to the source document notholding all the relevant information for the coder at the time/point of codingaffecting five primary and three secondary diagnoses.85 The coder errors were in the following areas:■ incorrect coding at the required 3-, 4- and 5- character level affectingfour primary and one secondary diagnosis, three primary and twosecondary procedures; and■ omission of diagnosis and procedures – affecting 17 secondarydiagnoses, nine primary and three secondary procedures.Financial impact of errorsTable 16 Chapter area: financial impact of errorsPre AuditPaymentPost AuditPaymentGrossChange% GrossChangeNetChange£46,626 £51,220 £4,594 9.9 £4,594 9.9% NetChange86 The sample of spells audited covered £46,626 of activity. The totalvalue of all errors regardless of who they favoured (gross change) was£4,594 (9.9 per cent of total sample tested). If the episodes and thereforespells had been coded according to the auditor coding, the impact wouldhave been an increase in income (net change) due to the Trust from itscommissioners of £4,594 or 9.9 per cent of payments tested.Data Issues87 There were no data issues identified within the chapter area.Audit Commission Payment by results data assurance framework 51
HRGs and price changes as a result of the audit (Chapter JC - SkinSurgery)Example 1ID Speclty 330 SubchapterEpisode Start 12/05/2010 End 12/05/2010TrustCodingAuditCodingError KeyPDiag L82X Seborrhoeic keratosis L82X Seborrhoeic keratosisProc1 S082 Curettage andcauterisation of lesion ofskin NECE092 Destruction of lesion ofexternal nose NECProc2 Z221 External nose S082 Curettage andcauterisation of lesion ofskin NECHRG JC15Z Skin Therapies level 3 CZ12Y Minor Nose Procedures19 years and overwithout CCSpellHRGJC15Z Skin Therapies level 3 CZ12Y Minor Nose Procedures19 years and overwithout CCCodingManual orCodingClinicreferencePPO OPCS 4.5instructionmanualPage S-5Base£635 £644tariffShort£0 £0stayadj.Speciali£0 £0st TopUpExcess£0 £0beddaysTotal£635 £644PriceCoding SourceClinical RecordThe coder should have selected a code from chapter E and there are specific codes for external nose then addedthe S code for more information.Audit Commission Payment by results data assurance framework 52
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THE ROYAL BOURNEMOUTH AND CHRISTCHU
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50/11 DECISION3% by the 4 th quarte
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52/11 INFORMATIONClinical advice -
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Board of Directors10 June 20111 Pur
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Board of Directors10 June 2011Part
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The Royal Bournemouth & Christchurc
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Board of Directors Part 110 June 20
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Board of Directors Part 110 June 20
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Board of Directors10 June 2011THE R
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Board of Directors - Part I10 th Ju
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Payment byresults dataassurancefram
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