View June's Board Pack - Royal Bournemouth Hospital

The net value of the HRGs that changed as a result of the errors identifiedin coding and correction of the spells in the sample would lead to a smalldecrease in total payments due to the Trust of £152. The level and mixtureof errors between those reducing or increasing payments indicates thatcoder error, rather than deliberate miscoding, is at the root of theinaccuracies.49 A summary of the impact of the errors on the HRG allocation andconsequent applicable tariff is given in Table 5 below:Table 6:AreaauditedPayment changes from pre to post auditSpells Pre PostAudit AuditPayment PaymentSpecialty/Subchapter/HRGValue of HRGChanges% change preand post auditGross Net Absolute NetTheme General 52 £79,712 £79,665 £4,245 -£47 5.3 -0.1MedicineSpecialty Cardiology 80 £201,825 £197,126 £4,699 - 2.3 -2.3£4,699SubchapterSkinSurgery70 £46,626 £51,220 £4,594 £4,594 9.9 9.9JCHRG EB01Z 19 £14,261 £14,261 £0 £0 0.0 0.0Overall 221 £342,424 £342,272 £13,538 -£152 4.0 -0.0Coding arrangements50 The coding arrangements are good leading to a decrease in the HRG,procedure and diagnosis error rates.51 The condition of the casenotes has been improved and new folders areissued when the original folder is in poor condition. However it is imperativethat further improvements to the medical record are progressed through theMedical Records User Group. As the coders use the electronic dischargesummary with the EPR this will have little impact on the coded data.52 Coding at the Trust is done using a combination of clinical terminology(READ codes) and then ICD-10 and OPCS 4.5 codes. Clinical terms arechosen first, and maps to the other classifications are then defined. Thismakes coding accuracy more difficult to achieve. This issue was raised inlast year's report and the Trust investigated possible system updates tocode directly to ICD-10 and OPCS 4.5 codes thereby avoiding theintermediate step of using clinical terminology (READ codes). It has beenagreed to update the system to allow the coders to directly code in ICD10and OPCS 4.5, the Trust are waiting for an implementation date.53 The key areas for the Trust to improve the coding accuracy are:■ removal of the policy regarding the use of a secondary procedure codefor angiograms when an angioplasty is undertaken. These are codeddue to clinical staff insisting these codes are added when an angiogramis done at the same time as an angioplasty. This is against the codingrule when diagnostic and therapeutic procedures are carried out on theAudit Commission Payment by results data assurance framework 13