The Online Journal of Clinical Audits, Vol 8, No 4 (2016)

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Payment by results: auditing the coding of procedures for Dupuytren’s contracture

Ian Leslie Sheldrake, Marlies Schreuder


Aims – Dupuytren’s contracture can be a debilitating disease caused by palmar fibromatosis. Surgical correction is commonly undertaken by several procedures. Healthcare Resource Group (HRG) codes form the basis of hospital funding via the current NHS ‘Payment by Results’ system. Varying procedures generate different HRG codes and thus have an altered ‘tariff’ attributed to them by non-clinical coders. An incorrect HRG code will result in the hospital being underpaid (or overpaid) for the work carried out. We aimed to determine if the HRG codes accurately reflected the procedures performed.


Methods – Tariffs allocated to a 6 month sample of 50 patients between October 2012 and October 2013 were obtained from the coding office. Operation notes were reviewed to determine the procedure performed and the tariff discrepancy calculated. Results were presented to all surgeons performing these operations locally to highlight the importance of clear operation note titles for use by non-clinical coders. A re-audit was undertaken between December 2013 and June 2014.


Results – Initial audit revealed a discrepancy of £76,201; 45% increase on the payment the hospital received. Re-audit showed a scaled discrepancy of £28,292. This was only a 13% increase. The majority of the discrepancy was caused by not coding for digital fasciectomies when both palmar and digital fasciectomies had been performed.


Conclusions – Our study shows the importance of clear operation note titles in ensuring accurate coding and may demonstrate an endemic problem throughout the NHS. A huge financial impact was made by simply increasing awareness amongst clinicians. The importance of coding should be emphasised across all departments and specialities to guard against loss of remuneration.

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