Abstract
Objective: Payment by results was introduced to the UK National Health Service in 2004. Specific payment tariff for ENT departments is determined by clinical code of the patient’s episode. Our aim was to review clinical coding in our department and assess scope for improving accuracy of coding and income tariffs.
Method: We retrospectively reviewed coding of operations over a 4-month period. A database was obtained including primary operation code and payment tariff. Using a system that grouped operation codes according to anatomic site, we analyzed each case to see if actual code attributed to the procedure could be improved.
Results: Over the 4-month period there were 930 operations; 866 (93%) were correctly coded with an optimal tariff, 19 (2%) were incorrectly coded giving an excessive total tariff of £24,840, and 45 (5%) were incorrectly coded losing a tariff of £37,381. Therefore, over the 4-month period, £12,541 was lost due to suboptimal coding.
Conclusion: A system that groups ENT operation codes according to anatomic regions and procedure types efficiently aids the accuracy and optimization of income tariffs. It may be employed during the clinical coding process as a quality assurance tool.
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