The audit was completed using version 3 of the NHS Connecting for Health (NHS CFH) clinical coding audit methodology on a sample of 100 finished consultant episodes (FCEs) from across the ISP. The sample was selected based on local knowledge supported by the output from the Audit Commission's PbR National Benchmarker which identifies areas where the ISP was an outlier.
The error rates were calculated by comparing the diagnosis and procedure codes recorded by the ISP with those recoded by the clinical coding auditor and then comparing the HRGs these generated. The financial impact of these errors was calculated by applying the PbR pricing algorithm (including HRG tariff, Long Stay Payments, Short Stay Adjustments and Specialised Service Adjustments) to the pre- and post-audit data to determine the financial impact of the changes.
In order to make comparisons between different independent sector providers and to NHS trusts all data was grouped to HRG4 PbR business rules.
|
Primary
Diagnoses
Incorrect |
Secondary
Diagnoses
Incorrect |
Primary
Procedures
Incorrect |
Secondary
Procedures
Incorrect |
HRGs
Incorrect |
Net
Monetary
Change |
| 2010/11 audit results |
83% |
68.9% |
33% |
10.5% |
43% |
6.3% |
Our national reports on previous years' audits suggested there are a number of issues which contribute to the errors including:
- quality of information available at the time of coding;
- poor policy and procedures;
- software issues;
- limited clinician involvement; and
- not implementing updated versions of classifications systems in a timely manner.