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63 The following areas for improvement have been identified:■ reinforcing 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.This accounted for 53.5 per cent of the errors in this area; and■ providing training to the coders to cover the definition of the primarydiagnosis. There were nine coder errors at primary diagnosis level (20.9per cent).64 There were 17 non-coder errors due to the source document not havingall of the information for the coder at the time/point of coding, this affectedthree primary and 12 secondary diagnoses plus two primary procedures.65 The coder errors were in the following areas:■ incorrect coding at the required 3-, 4- and 5- character level affectingseven primary and four secondary diagnoses and two primaryprocedures; and■ omission of diagnosis and procedures – affecting two primary and 11secondary diagnoses.66 There are 10 instances when information not relevant to the episode ofcare has been coded. NHS CFH does not treat this as an error and werethey to have been included they would have accounted for none of the HRGchanges. The Trust should seek to code only relevant information.Follow up of audit in this area from 2009/1067 General Medicine was audited in 2009/10 and was selected as an areafor follow up. It is important to note that different OPCS versions may havebeen in use at the time of the audits. This can have an impact on the overallHRG error rate.Table 9: Follow up of HRG changesEpisodes2010/11 2009/10 ChangeTotal 100 100 -Total changingHRG 7 35 -28% changingHRG 7.0% 35.0% -28.0%68 The HRG and coding error rate have improved considerably since2009/10. This result could be better if training was provided coveringprimary diagnosis definition and the March 2010 Coding Clinic regarding thecoding of relevant mandatory co-morbidities.Audit Commission Payment by results data assurance framework 22