scholarly journals Audit of Clinical Coding of Major Head and Neck Operations

2009 ◽  
Vol 91 (3) ◽  
pp. 245-248 ◽  
Author(s):  
Indu Mitra ◽  
Tass Malik ◽  
Jarrod J Homer ◽  
Sean Loughran
Keyword(s):  
Head And Neck ◽  
Coding System ◽  
Clinical Coding ◽  
Tertiary Referral Centre ◽  
Surgical Trainee ◽  
Diagnostic Codes ◽  
Consistent Manner ◽  
Resource Group ◽  
Procedure Codes ◽  
Healthcare Resource Group

INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.

Assessing the Accuracy of Clinical Coding in Orthopaedic Day Surgery Patients

2013 ◽  
Vol 95 (1) ◽  
pp. 14-16 ◽  
Author(s):  
A Razik ◽  
V Venkat-Raman ◽  
FS Haddad
Keyword(s):  
Healthcare Resource ◽  
Day Surgery ◽  
Clinical Coding ◽  
Resource Group ◽  
Healthcare Resource Group

The NHS is funded via a 'payment by results' system, whereby hospitals are paid for the work they do instead of being allocated a certain amount to spend each year. Every patient treated in hospital is coded to a Healthcare Resource Group (HRG) based on the specifics of his or her admission. There are numerous HRGs, with each one reflecting particular levels of resources that would have been used.

Does a coding sticker for percutaneous nephrolithotomy improve clinical coding accuracy and increase financial remuneration?

2017 ◽  
Vol 10 (5) ◽  
pp. 435-439
Author(s):  
JF Donati-Bourne ◽  
R Bodalia ◽  
D Muthuveloe ◽  
JA Inglis ◽  
NJ Rukin
Keyword(s):  
Retrospective Study ◽  
Percutaneous Nephrolithotomy ◽  
Healthcare Resource ◽  
Single Centre ◽  
Clinical Coding ◽  
Resource Group ◽  
Operation Note ◽  
Healthcare Resource Group

Objective: This study aimed to evaluate whether a coding sticker for percutaneous nephrolithotomy (PCNL), completed by the surgeon after the operation note, improved the accuracy of clinical coding and the financial remuneration for PCNL. Patients and methods: A retrospective study was undertaken including all PCNLs performed in a single centre between October 2014 and June 2016. PCNL clinical coding was obtained and applied to yield a Healthcare Resource Group (HRG) code, which was in turn used to calculate the tariff the Trust received for the case. Remuneration and clinical coding accuracy were compared pre- and post-coding sticker introduction. Results: Thirty-three cases were included in the study. Eleven patients were reviewed before the introduction of the sticker and 22 after the introduction of the PCNL sticker. Overall mean clinical coding accuracy improved from 65% to 94% after the stickers’ introduction. This resulted in an overall mean increase in remuneration of £501 per case (from £2946 to £3447). Conclusion: The implementation of a simple coding sticker for completion after a PCNL improves clinical coding accuracy and increases the financial remuneration.

A Systematic Review of Coding Systems Used in Pharmacoepidemiology and Database Research

2018 ◽  
Vol 57 (01/02) ◽  
pp. 01-42 ◽  
Author(s):  
Yong Chen ◽  
Marko Zivkovic ◽  
Su Su ◽  
Jianyi Lee ◽  
Edward Bortnichak ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Setting ◽  
English Language ◽  
Data Extraction ◽  
Therapeutic Area ◽  
Coding System ◽  
Clinical Coding ◽  
Real World Data ◽  
Coding Systems ◽  
Database Research

Summary Background: Clinical coding systems have been developed to translate real-world healthcare information such as prescriptions, diagnoses and procedures into standardized codes appropriate for use in large healthcare datasets. Due to the lack of information on coding system characteristics and insufficient uniformity in coding practices, there is a growing need for better understanding of coding systems and their use in pharmacoepidemiology and observational real world data research. Objectives: To determine: 1) the number of available coding systems and their characteristics, 2) which pharmacoepidemiology databases are they adopted in, 3) what outcomes and exposures can be identified from each coding system, and 4) how robust they are with respect to consistency and validity in pharmacoepidemiology and observational database studies. Methods: Electronic literature database and unpublished literature searches, as well as hand searching of relevant journals were conducted to identify eligible articles discussing characteristics and applications of coding systems in use and published in the English language between 1986 and 2016. Characteristics considered included type of information captured by codes, clinical setting(s) of use, adoption by a pharmacoepidemiology database, region, and available mappings. Applications articles describing the use and validity of specific codes, code lists, or algorithms were also included. Data extraction was performed independently by two reviewers and a narrative synthesis was performed. Results: A total of 897 unique articles and 57 coding systems were identified, 17% of which included country-specific modifications or multiple versions. Procedures (55%), diagnoses (36%), drugs (38%), and site of disease (39%) were most commonly and directly captured by these coding systems. The systems were used to capture information from the following clinical settings: inpatient (63%), ambulatory (55%), emergency department (ED, 34%), and pharmacy (13%). More than half of all coding systems were used in Europe (59%) and North America (57%). 34% of the reviewed coding systems were utilized in at least 1 of the 16 pharmacoepidemiology databases of interest evaluated. 21% of coding systems had studies evaluating the validity and consistency of their use in research within pharmacoepidemiology databases of interest. The most prevalent validation method was comparison with a review of patient charts, case notes or medical records (64% of reviewed validation studies). The reported performance measures in the reviewed studies varied across a large range of values (PPV 0-100%, NPV 6-100%, sensitivity 0-100%, specificity 23-100% and accuracy 16-100%) and were dependent on many factors including coding system(s), therapeutic area, pharmacoepidemiology database, and outcome. Conclusions: Coding systems vary by type of information captured, clinical setting, and pharmacoepidemiology database and region of use. Of the 57 reviewed coding systems, few are routinely and widely applied in pharmacoepidemiology database research. Indication and outcome dependent heterogeneity in coding system performance suggest that accurate definitions and algorithms for capturing specific exposures and outcomes within large healthcare datasets should be developed on a case-by-case basis and in consultation with clinical experts.

scholarly journals Coding Systems for Clinical Decision Support: Theoretical and Real-World Comparative Analysis (Preprint)

2019 ◽  
Author(s):  
Nicolas Delvaux ◽  
Bert Vaes ◽  
Bert Aertgeerts ◽  
Stijn Van de Velde ◽  
Robert Vander Stichele ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
International Classification Of Diseases ◽  
Coding System ◽  
Clinical Coding ◽  
Coding Systems

BACKGROUND Effective clinical decision support systems require accurate translation of practice recommendations into machine-readable artifacts; developing code sets that represent clinical concepts are an important step in this process. Many clinical coding systems are currently used in electronic health records, and it is unclear whether all of these systems are capable of efficiently representing the clinical concepts required in executing clinical decision support systems. OBJECTIVE The aim of this study was to evaluate which clinical coding systems are capable of efficiently representing clinical concepts that are necessary for translating artifacts into executable code for clinical decision support systems. METHODS Two methods were used to evaluate a set of clinical coding systems. In a theoretical approach, we extracted all the clinical concepts from 3 preventive care recommendations and constructed a series of code sets containing codes from a single clinical coding system. In a practical approach using data from a real-world setting, we studied the content of 1890 code sets used in an internationally available clinical decision support system and compared the usage of various clinical coding systems. RESULTS SNOMED CT and ICD-10 (International Classification of Diseases, Tenth Revision) proved to be the most accurate clinical coding systems for most concepts in our theoretical evaluation. In our practical evaluation, we found that International Classification of Diseases (Tenth Revision) was most often used to construct code sets. Some coding systems were very accurate in representing specific types of clinical concepts, for example, LOINC (Logical Observation Identifiers Names and Codes) for investigation results and ATC (Anatomical Therapeutic Chemical Classification) for drugs. CONCLUSIONS No single coding system seems to fulfill all the needs for representing clinical concepts for clinical decision support systems. Comprehensiveness of the coding systems seems to be offset by complexity and forms a barrier to usability for code set construction. Clinical vocabularies mapped to multiple clinical coding systems could facilitate clinical code set construction.

scholarly journals 515. Evolution of Treatment Patterns for Patients Hospitalized with COVID-19 in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S359-S360
Author(s):  
Kelly Zalocusky ◽  
Shemra Rizzo ◽  
Devika Chawla ◽  
Yifeng Chia ◽  
Tripthi Kamath ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
The United States ◽  
Hospitalized Patients ◽  
Invasive Ventilation ◽  
Data Set ◽  
Diagnostic Codes ◽  
Dramatic Decline ◽  
The Us ◽  
Optimal Patient Care ◽  
Procedure Codes

Abstract Background COVID-19 remains a threat to public health, with over 30 million cases in the US alone. As understanding of optimal patient care has improved, treatment guidelines have continued to evolve. This study characterized real-world trends in treatment for US patients hospitalized with COVID-19, stratified by whether patients required invasive ventilation. Methods US patients diagnosed and hospitalized with COVID-19 between March 23 and December 31, 2020, in the Optum de-identified COVID-19 electronic health record (EHR) data set were identified. Both drug and procedure codes were used to ascertain medications, and both procedure and diagnostic codes were used to detect invasive ventilation during hospitalization. Medication trends were estimated by computing proportions of hospitalized patients receiving each drug weekly during the study period. Results In this cohort of 71,366 hospitalized patients, the largest observed change in care was related to chloroquine/hydroxychloroquine (HCQ) (Figure). HCQ usage peaked at 87% of patients receiving invasive ventilation (54% without ventilation) in the first week of this study (March 23-29), but declined to < 5% of patients, regardless of ventilation status, by the end of May. In contrast, dexamethasone usage was 10% at baseline in patients receiving ventilation (1% without ventilation) and increased to a steady state of >85% of patients receiving ventilation ( >50% without ventilation) by the end of June. Similarly, remdesivir usage increased sharply from a baseline of 2% of patients and continued to rise to a peak of 79% of patients receiving invasive ventilation (44% without ventilation) in November before declining. Conclusion Meaningful shifts in treatments for US patients hospitalized with COVID-19 were observed from March through December 2020. A dramatic decline was observed for HCQ use, likely owing to safety concerns, while usage of dexamethasone and remdesivir increased as evidence of their efficacy mounted. Across medications, usage was substantially more prevalent among patients requiring invasive ventilation compared with patients with less severe cases. Disclosures Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Yifeng Chia, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Tripthi Kamath, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Larry Tsai, MD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee)

scholarly journals Payment by volume (not results)

2007 ◽  
Vol 13 (1) ◽  
pp. 7-9 ◽  
Author(s):  
Femi Oyebode
Keyword(s):  
Mental Health ◽  
Resource Use ◽  
Healthcare Resource ◽  
Case Mix ◽  
Hospital Funding ◽  
Resource Group ◽  
Related Group ◽  
Consistent Basis ◽  
Healthcare Resource Groups ◽  
Healthcare Resource Group

Payment by results, a system for paying healthcare trusts, is intended as a fair and consistent basis for hospital funding. It relies on a national tariff structured around a case-mix measure known as healthcare resource groups. It is often argued that if payment by results works as planned, the National Health Service will become more efficient and productive. However, the use of a case-mix measure, the healthcare resource group, which derives from the diagnostic related (or diagnosis-related) group, has attendant problems. These include the risk that the payment structure will be inaccurate, unfair and liable to cause the financial destabilisation of trusts. There is also the risk that healthcare institutions will falsify patient classifications (‘up-coding’) to ensure higher remuneration. It has been argued that payment by results may be particularly unsuited to psychiatry. The ability of healthcare resource groups to accurately predict resource use in psychiatry is doubtful. In conclusion, mental health trusts will need to adapt to payment by results but there will inevitably be losers.

scholarly journals Value of oesophagoscopy and bronchoscopy in diagnosis of synchronous malignancies in patients with head and neck squamous cell carcinomas

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shi Yeung Ho ◽  
Raymond King Yin Tsang
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Squamous Cell ◽  
Imaging Techniques ◽  
Hypopharyngeal Cancer ◽  
Squamous Cell Carcinomas ◽  
Tertiary Referral Centre ◽  
Lung Malignancies ◽  
Synchronous Malignancies ◽  
Male Patients

Abstract Background Routine screening of patients with head and neck squamous cell carcinomas (HNSCCs) for synchronous malignancies using oesophagoscopy and bronchoscopy had been controversial. The aim of this study is therefore to find out the rate of synchronous malignancies in patients with primary HNSCCs, the risk factors for its occurrence and the effectiveness of oesophagoscopy and bronchoscopy from a 10-year experience in a single centre. Methods A retrospective review of medical records was conducted from July 2008 to June 2018 in a tertiary referral centre in Hong Kong. All patients with newly diagnosed HNSCCs were screened with oesophagoscopy and bronchoscopy at the time of diagnosis and therefore all patients were included in the study. The incidence of synchronous malignancies along the aerodigestive tract and the yield of oesophagoscopy and bronchoscopy were studied. Results Of the 702 patients included in the study, the overall rate of synchronous malignancies was 8.3% (58/702), with the rate of synchronous oesophageal and lung malignancies being 5.8% (41/702) and 0.85% (6/702) respectively. Fourteen out of the 41 oesophageal malignancies were only detectable with oesophagoscopy. Only one of the synchronous lung malignancies was detectable by bronchoscopy. Risk factors for synchronous malignancies include male gender, smokers, drinkers and primary hypopharyngeal cancer. Conclusions Oesophagoscopy is essential for detecting synchronous oesophageal malignancies in patients with HNSCCs especially in male patients, smokers and drinkers, and it is most valuable in primary hypopharyngeal cancer patients among all primary subsites. Bronchoscopy had a low yield for synchronous lung malignancies and can be potentially replaced by imaging techniques.

Validity of anaesthetic complication coding data as a clinical indicator

2012 ◽  
Vol 36 (2) ◽  
pp. 229 ◽  
Author(s):  
Andrew Jones ◽  
John P. Monagle ◽  
Susan Peel ◽  
Matthew W. Coghlan ◽  
Vangy Malkoutzis ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Tertiary Hospital ◽  
Risk Identification ◽  
Positive Development ◽  
Coding System ◽  
Clinical Coding ◽  
Clinical Indicators ◽  
Icd 10 ◽  
International Statistical Classification

Clinical indicators using routinely collected International Statistical Classification of Diseases, Australian Modification (ICD–10–AM) data offer promise as tools for improvement of quality. The ICD–10–AM is the coding system used by Australian administrators to summarise information from the clinical record to describe a patient’s hospital encounter. The use of anaesthesia complications as coded by this system has been proposed by two jurisdictions as a monitor of the quality of anaesthetic services. We undertook a review of cases identified by such indicators in a large tertiary hospital. Our results indicate the anaesthesia indicator dataset proposed by the Victorian and Queensland Health departments appears to have little clinical or quality improvement relevance. What is known about the topic? Quality assurance relies on reviewing performance, highlighting issues and eliminating or minimising the identified risks. Case or risk identification in the medical arena relies heavily on self reporting, which has many flaws. A system not dependent on self reporting that was reliable would be a positive development in the pursuit of quality improvement. What does this paper add? ICD-AM-10 coding was used to identify complications attributable to anaesthesia as defined by the coding system. The cases identified were then reviewed for the clinical accuracy of this information. The clinical coding was accurate, but the clinical case load so identified did not accurately reflect real incidents of anaesthesia-related complications. The ICD AM 10 codes, as they relate to anaesthesia complications, do not provide a reliable method of identifying cases that contribute to anaesthetic quality assurance activities. What are the implications for practitioners? Anaesthesia quality assurance continues to be dependent on self reporting of relevant cases. Coded data do not provide an adequate substitute for the self reporting mechanisms.

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