Implications of miscoding urological procedures in an era of financial austerity – ‘Every Penny Counts’

OBJECTIVES: The study aimed to find out any inaccuracy in coding of elective urology procedures and associated financial implications. DESIGN: Retrospective audit and re-audit. SETTINGS: Introduction of payment by results was introduced in the NHS in England in 2002. This meant that hospitals are paid on individual patient basis according to their human resource group (HRG) rather than a block contract. Current coding system uses office of population census and surveys classification. These along with other variables determine the final human resource group code defining final payment. PARTICIPANTS: None. MAIN OUTCOME MEASURE: Retrospective analysis of coding for all inpatient urological procedures was performed over a period of two months. All documented Office of Population Census and Surveys codes were recorded and reviewed by urology trainee along with the head of professional coders. As a result of first analysis the deficiencies were identified and revised Office of Population Census and Surveys codes were used to generate the final human resource group codes. After six months a re-audit was done. RESULTS: In the initial study, 121 cases were reviewed. Twenty per cent of these cases were miscoded. The revised Office of Population Census and Surveys codes led to change of final human resource group code and hence recovery of a payment of £10,716. Analysis after six months showed a considerable improvement with incorrect coding reduced to 11%. CONCLUSION: Our findings highlight potential discrepancies in coding which can lead to significant financial loss. It is important that surgeons involve and train the coding department so that coding errors can be avoided. This will put us in better position to deal with Nicolson Challenge.