Maternity delivers on the detail
Good data is fundamental to Payment by Results (PbR). Payments depend upon the precision of the recorded diagnosis or procedure. Depth of coding – getting right down to the detail – can be of the utmost importance.
The Audit Commission’s PbR data assurance framework focuses on the quality of data that underpins PbR. The indicators it has developed have highlighted one specific trend above all others: maternity always comes out at the top of the pile for its depth of coding.
Maternity services can get a bad press where PbR is concerned – debates between providers and commissioners abound over the notorious N12 code, where attendances that could be viewed as part of the original birth episode are coded as separate episodes at a cost of £461 a time.
Other accusations of income generation focus on upcoding to more expensive healthcare resource groups (HRGs). The theory is that upcoding is more easily possible – and incentivised – where HRGs are split between those with and without complications. Gastroenterology has similar ratios of ‘with complication’ HRGs and, therefore, presumably, similar opportunities and incentives for upcoding. However, its performance on depth of coding, which enables a distinction to be made between conditions with and without complications, is much poorer.
Another theory is that upcoding will creep forward as the incentives under PbR bite deeper. However, there has been little change in the depth of maternity coding since PbR tariffs were introduced. There is also remarkable consistency between trusts, suggesting that depth of coding in maternity has been there for some time.
One possible explanation may be that maternity services have particularly strong incentives to keep very good clinical records. Deaths from endoscopies are few and far between – maternity on the other hand has a much higher mortality risk, and perinatal deaths can receive considerable attention, both locally and nationally. Detailed coding means easy access to the appropriate data for clinical audit – it helps understanding and more easily enables clinicians to review what has happened and why.
These incentives and needs apply to other specialties but it is noteworthy that maternity services come out top on depth of coding. And it is always relevant to remember that good quality data for PbR are good quality data for clinical purposes too.