Surgeon involvement in clinical coding to improve data accuracy and remuneration in a shoulder and elbow unit

Abstract

Background: Clinical coders are dependent on clear data regarding diagnoses and procedures to generate an accurate representation of clinical activity and ensure appropriate remuneration is received. The accuracy of this process may potentially be improved by collaboration with the surgical team.

Methods: Between November 2017 and November 2019, 19 meetings took place between the Senior Clinical Fellow of our tertiary Shoulder & Elbow Unit and the coding validation lead of our Trust. At each meeting, the Clinical Fellow assessed the operative note of cases in which uncertainty existed as to the most suitable clinical codes to apply and selected the codes which most accurately represented the operative intervention performed.

Results: Over a 24-month period, clinical coding was reviewed in 153 cases (range 3-14 per meeting, mean 8). Following review, the clinical coding was amended in 102 (67%) of these cases. A total of £115,160 additional income was generated as a result of this process (range £1677-£15,796 per meeting, mean £6061). Only 6 out of 28 (21%) cases initially coded as arthroscopic sub-acromial decompressions were correctly coded as such.

Discussion: Surgeon input into clinical coding greatly improves data quality and increases remuneration received for operative interventions performed.

Keywords: Coding; clinical; data; remuneration; validation.

Figure 1.

A chart illustrating number of cases assessed and amended at each coding MDT meeting.

Figure 2.

Post-operative radiograph of case reviewed at coding MDT demonstrating a reverse shoulder arthroplasty with a cemented stem. Codes before validation: W97.5 Primary reverse polarity total prosthetic replacement of shoulder joint not using cement; Z94.2 Right-sided operation; HRG Code: HN52C; Tariff: £5475 Codes after validation: O40.1 Primary reverse polarity hybrid prosthetic replacement of shoulder joint using cement; Z69.1 Head of humerus (denotes prosthesis cemented on humeral side); Z94.2 Right-sided operation; HRG Code: HN86B; Tariff: £6419 Difference in tariff of +£944

Figure 3.

(a) and (b) Pre and post-operative radiographs of case reviewed at coding MDT demonstrating 2nd stage revision of total elbow replacement to distal humeral replacement. Codes before validation: O21.3 Revision of total prosthetic replacement of elbow joint using cement; Y71.1 Subsequent stage of staged operations NOC; HRG Code: HN85Z; Tariff: £7946 Codes after validation: O21.3 Revision of total prosthetic replacement of elbow joint using cement; Y71.1 Subsequent stage of staged operations NOC; W05.2 Implantation massive endoprosthetic replacement of bone; Z69.7 Lower end of humerus NEC; A67.1 Ulnar nerve release; HRG Code: HN87Z; Tariff: £17,717 Difference in tariff of +£9771.

Figure 4.

A chart demonstrating the additional income generated from each coding MDT meeting as a result of amending clinical codes.