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Clinical coding improves but third of trusts still overcharging

Hospital trusts have improved their clinical coding, but a third are still overcharging commissioners by as much as 6 per cent, the latest audit results show.

The Audit Commission has been publishing the individual results of its audit of each NHS secondary care provider’s payment by results coding. It is due to publish a final report next week.

Analysis of the 145 results published so far suggests most trusts improved the accuracy of their coding betwee n 2007-08 and 2008-09.

Last year the commission found that, on average, 9.4 per cent of the bills trusts sent to commissioners were for the wrong healthcare resource group (HRG) code. But it dismissed concerns that trusts were “up-coding” procedures and diagnoses deliberately to produce higher bills, saying coding errors had led to both under and overcharging with a net effect close to zero.

The coding errors are still a concern as they undermine planning and the robustness of epidemiological data.

The 145 results show an average HRG error rate in 2008-09 of 8 per cent. The net effect on the amounts charged to commissioners was a 0.3 per cent undercharge. A comparison between years is of limited use as the audit is based on a small sample of deliberately targeted codes, including areas highlighted locally as problematic.

The audits show significant variation persists between providers. Dartford and Gravesham trust’s results show that 24 per cent of their HRG codes were incorrect, causing them to overcharge commissioners by 3.2 per cent. That compares with Wrightington, Wigan and Leigh foundation trust where auditors found no HRG errors.

A spokesman for Dartford and Gravesham said the errors stemmed from the systematic miscoding of two specific procedures which resulted in the wrong bills being produced, but this had been corrected following the auditor’s report.

The biggest overcharger was Dorset County foundation trust, where 11 per cent of HRG codes were wrong, leading to a 5.8 per cent overcharge.

A spokeswoman said that was down to one procedure being incorrectly coded and the primary care trust had now been refunded. She added: “We have got a very good record for coding - this was a one-off incident which was addressed quickly and resolved.”

Biggest over- and under-chargers
Source: Based on 145 audit reports published by the time HSJ went to press
 Overall coding errors% under/over-charged
Dorset County Hospital Foundation10.75.8
Nottingham University Hospitals165.2
The Queen Elizabeth Hospital King’s Lynn63.4
Barts and The London17.7-8
Queen Elizabeth Hospital16.3-6.4
Brighton and Sussex University Hospitals16.7-5.7


Readers' comments (3)

  • Maybe it has something to do with how we value the Coders! In the USA the Coding personnel are highly paid. Contrast this with the UK?

    Unsuitable or offensive?

  • Given that in primary care the coding reflects the actual content of the patient record for the purposes of direct patient care, the term clinical coding would appear to me to be accurate. Given that in secondary care the coding reflects classification of the information contained in the record according to a set of rules for a specific purpose in this case payment the term clinical coding would appear to me to be inaccurate. It would be really helpful in a holistic view of care if we used more accurate terms. So in this case we are dealing with PbR Classification Coding. This is not simply academic as Classification Coding rules may conflict or may create pervasive incentives for Record Content Coding and even individual care. Record Content Coding is about the coding of actual patient and client records for direct care by health and social care professionals.

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  • Are the HSJ headline writers employed by comissioners? The headline is true and misleading without reading the whole article.

    Overall Trusts are undercharging. Hence the peice could equally well or prehaps better (given that the undercharging is greater than the overcharging) have been titled:

    HEADLINE: Clinical coding improves but [appropriate proportion] of trusts still undercharging

    STRAPLINE: Hospital trusts have improved their clinical coding, but [appropriate proportion] are still undercharging commissioners by as much as 8 per cent, the latest audit results show.

    Neither headline is as close to balanced reporting as the almost balanced effect of the under and overchaging. However I realise "Coding improves and comissioners slightly undercharged as trusts under and overcharging balance out" is rather a boring headline despite the reading having a much more clear understsanding of the whole story.

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