Northampton General Hospital NHS Trust Quality Account 2016-2017

Themes of Good Practice Noted
Standard of oncology chemotherapy coding was exceptional, both procedurally and
diagnostically.
Obstetric coding was of a high standard in the midst of some complex cases within the
sample.
Inpatient orthopaedic and general surgery was generally coded to a good standard.
Sources of error:
Errors in the application of the primary diagnosis definition among a number of the coding
team.
o Driven by insufficient analysis of the full medical record where there is a conflicting
main condition stated on the discharge letter.
Errors in low complexity e.g. emergency medicine.
Specific issues identified in coding for functional endoscopic sinus surgery (FESS)
operations and the necessary code sequencing.
Simple primary diagnosis errors noted within oral surgery.
Histology reports not always referenced to update the coding.
Some errors associated with non-recording of external cause codes.
Evidence of coders not confining some diagnosis codes to the episode in which they were
relevant.
Conclusions
The overall results met the required standard to reach IG level 2 across every Division which is
positive. There were some particular areas identified where the coding was of a very good
standard and this included the more complex activity within the sample. Errors were found within
more low complexity, short stay spells.
The main priority for the department will be to highlight the importance of the primary diagnosis.
This will also include reference to the discharge letter where there is a ‘main condition stated’
recorded by the clinician.
There were some specific training needs identified in relation to ENT surgery which will be
addressed.
Work will be undertaken to ensure that multi-episode spells are extracted and coded at the same
time within the coding office. This will assist with ensuring episodes are coded in isolation.
Actions undertaken
Developed an intra-departmental project to place emphasis on improving primary diagnosis
accuracy.
Ensured that coders can view episode start/end times when extracting from notes on
wards.
Notes to be coded within the coding department for wards where multi-episode spells
occur.
Provided cross-departmental training on Head & Neck coding with a particular focus on
FESS surgery.
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