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72 The following areas for improvement have been identified:■ 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 thesame site at the same theatre visit on the same body site, only thetherapeutic procedure should be recorded. This was the cause of all ofthe HRG changes within Cardiology; and■ documenting the specific type of image control within the casenotes andthe EPR. The coding of Cardiology procedures could be more specific ifthis information is available to the coder.73 There were 23 non-coder errors due to the source document notholding all the relevant information for the coder at the time/point ofcoding this affected one primary and 22 secondary diagnoses. The noncoder errors accounted for 82.1 per cent of the total number of errors inthis area.74 The coder errors were in the following areas:■■incorrect sequencing where the diagnosis or procedure was identifiedbut not coded in the correct order - affecting one primary and twosecondary procedures; andomission of diagnosis and procedures – affecting two secondarydiagnoses.75 There are 11 instances when information not relevant to the episode ofcare has been coded. NHS CFH does not treat this as an error but werethey to have been included they would have accounted for all 10 of the HRGchanges. These are all due to clinical input requesting Angiograms arecoded alongside an Angioplasty procedure. This does not comply withnational standards as diagnostic procedures should not be coded when atherapeutic procedure is undertaken at the same time and on the same site.The Trust should seek to code only relevant information.Follow up of audit in this area from 2007/0876 Cardiology was audited in 2007/08 and was selected as an area forfollow up. To enable an accurate HRG level comparison between the2007/08 and 2010/11 audits we have regrouped the 2007/08 audit data toHRG4. This is what the error rate would have been if HRG4 was in use in2007/08 and shows that HRG coding has improved compared to 2007/08when this area was originally audited. It is important to note that differentOPCS versions may have been in use at the time of the audits. This canhave an impact on the overall HRG error rate.Audit Commission Payment by results data assurance framework 35
Table 13: Follow up of HRG changesEpisodes2010/11 2007/08 ChangeTotal 100 100 -Total changingHRG 10 3 7% changing HRG 10.0% 3.0% 777 The coding error rate has improved since 2007/08 however the HRGrate has deteriorated. This is due to the policy at the Trust regarding theuse of a secondary procedure code for angiograms when an angioplasty isundertaken as this accounted for all of the HRG changes in this area.Financial impact of errorsTable 14: Specialty B area: financial impact of errorsPre AuditPaymentPost AuditPaymentGrossChange% GrossChangeNetChange£201,825 £197,126 £4,699 2.3 -£4,699 -2.3% NetChange78 The sample of spells audited covered £201,825 of activity. The totalvalue of all errors regardless of who they favoured (gross change) was£4,699 (2.3 per cent of total sample tested). If the episodes and thereforespells had been coded according to the auditor coding, the impact wouldhave been a decrease in income (net change) due to the Trust from itscommissioners of £4,699 or 2.3 per cent of payments tested.Data Issues79 There were no data issues identified within the Specialty B area.Audit Commission Payment by results data assurance framework 36
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THE ROYAL BOURNEMOUTH AND CHRISTCHU
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