Coding errors in NHS cause up to £1bn worth of inaccurate paymentsBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4734 (Published 31 August 2010) Cite this as: BMJ 2010;341:c4734
All rapid responses
One of the reasons why coding is so often done badly (and by poorly
paid administrative staff remote from the clinical activity) is that it is
perceived to be just about the money and not at all relevant to providing
better care to patients. Some would argue that it is just a bureaucratic
overhead that is a byproduct of the creeping commercialisation of the NHS.
But this is a serious mistake. Clinicians can and should use coding
to monitor the quality of their work. Accurate recording of what they do
for patients and the outcomes that result is the foundation of continuous
improvement in their working practices. Atul Gawande (the American
surgeon) tells the story of how US military medics halved the death rates
from battlefield injuries by being very diligent in recording the
diagnoses of soldier injuries, the treatments given, the outcomes and
reviewing all three to seek best practices and opportunities to improve. A
naive outsider might assume that such practice was routine across all of
medicine, but it clearly is not.
Unless we accept the view that medics arise fully formed and perfect
from their training and never again need to learn or improve, accurate
coding is an essential part of the drive to improve outcomes for patients.
Competing interests: No competing interests
It is nonsense to call the process done by hospital coding staff
'clinical coding' simply because they code in ICD10 (diagnostic codes) and
OPCS4 (Operative procedure codes) and produce DRGs and HRGs for the sole
purpose of claims for payment to PCTs. Only clinicians can do valid
clinical coding as only they know what has been diagnosed and what has
been done to their patients.
As O'Dowd says clinicians should get involved but new computer
systems now being put in hospital still do not have have coded Electronic
Medical Records so it is unlikely that clinicians can get involved in the
foreseeable future. Maybe the government's new GP Practice Based
Comissioning regime will insist on it as part of commissioning services.
Now there's an idea!
Dr Roger Weeks
London SW14 7DF
Competing interests: Roger Weeks is Chairman of DIN, a charity that collects and audits anonymised data from GP clinical systems to improve patient care.