Ep 21 - Code for Cash and Credibility

The Crucial Role of Accurate Coding in Emergency Medicine: Insights from St Emlyns

Welcome to the St Emlyns blog! Today, we dive into a topic often overlooked but crucial to the functioning and financial health of emergency departments (ED): coding. This subject might not have the drama of resuscitations or surgical interventions, but it significantly impacts how we are perceived and funded. In this post, we explore how coding works in the context of emergency medicine in England, why it matters, and how we can improve our practices for better outcomes.

Understanding Coding in Emergency Departments

What is Coding?

In the simplest terms, coding is the process of translating medical activities into standardized codes that determine how much a hospital gets paid for the services provided. This is done through systems like the HRG-4 (Health-Related Grouping) codes, which classify the treatments and investigations performed on patients.

Why is Coding Important?

Accurate coding is essential because it directly affects the revenue of an emergency department. The details recorded in discharge summaries play a significant role in determining the funds a hospital receives. For instance, different procedures and investigations, like CT scans or blood tests, have specific codes that contribute to the total amount of money paid to the hospital.

The Financial Implications of Coding

Top Earning Codes in Emergency Medicine

The highest amount an ED can earn for a single patient episode is £237, applicable in cases involving resuscitation, thrombolysis, or laser eye surgery. However, if no tests or treatments are performed, the hospital only earns £58 for that patient. This stark difference underscores the importance of detailed and accurate coding.

Common Investigations and Their Codes

• MRI/CT Scans: High-value procedures that significantly boost the hospital's revenue.
• Ultrasound Scans: Similarly valued to MRI/CT scans, contributing substantial amounts to the hospital's income.
• Vital Signs Recording: Even basic procedures like recording vital signs can elevate the payment from the lowest tariff.

Challenges in Implementing Accurate Coding

Perception vs. Reality

Many healthcare professionals, including doctors and nurses, often view coding as an administrative burden rather than a critical part of patient care. This perception needs to change, as the quality of coding affects not only financial outcomes but also how the department's efficiency and effectiveness are perceived by external bodies like the CCG (Clinical Commissioning Groups).

The Role of IT Systems

Modern IT systems have made the coding process more streamlined, though they are not without their challenges. Integrating coding tasks into daily routines, such as through discharge summaries and GP letters, can help ensure that all activities are recorded accurately.

Improving Coding Practices

Education and Awareness

Educating staff about the importance of coding and its impact on both departmental funding and patient care is crucial. Junior doctors and new consultants should be made aware of how their input affects the overall picture.

Dedicated Coding Staff

Some hospitals have experimented with employing dedicated coding staff who review and correct coding entries, leading to significant increases in revenue. This approach can alleviate the burden on clinicians and ensure more consistent and accurate coding.

Streamlining Processes

Integrating coding into clinical workflows can make it less of a chore. For example, requesting an X-ray through the hospital's system should automatically record it in the patient's coding data. Such improvements can simplify the process and reduce the likelihood of missed entries.

The Impact of Coding on Departmental Perception

Meeting Standards and Avoiding Fines

In England, EDs are required to meet specific standards, such as the four-hour wait time target. Failing to meet these standards can result in fines, which further strain departmental resources. Accurate coding helps present a true picture of the department's workload and efficiency, potentially mitigating some of these financial penalties.

Communicating with Commissioners

Accurate coding ensures that commissioners have a clear understanding of the services provided by the ED. Misrepresentations can lead to misconceptions about the department's performance and the appropriateness of patient attendances, affecting future funding and policy decisions.

Case Study: VB11Z Code

The VB11Z code, which indicates that no investigations or treatments were performed, often misrepresents the actual work done in the ED. For example, patients admitted under the care of other specialists but using ED resources might be incorrectly coded, leading to a loss of revenue. By addressing such coding inaccuracies, departments can better reflect their true workload and resource needs.

Practical Tips for Better Coding

Record Everything

Ensure that all procedures, tests, and treatments are recorded, no matter how minor they might seem. This includes vital signs, which can elevate the payment bracket significantly.

Integrate Coding with Patient Care

Make coding part of the routine patient care process. For example, use discharge summaries to not only inform GPs but also to ensure all activities are coded.

Leverage Technology

Utilize the full capabilities of IT systems to automate and streamline coding tasks. This can reduce the manual burden and improve accuracy.

Continuous Training

Regularly update staff on coding practices and the importance of accurate data entry. This helps maintain awareness and reduces the risk of complacency.

Conclusion

While coding might not be the most glamorous aspect of emergency medicine, it is undeniably one of the most crucial. Accurate coding not only ensures that departments are properly funded but also that they are accurately represented in terms of workload and efficiency. By integrating better coding practices into daily routines and educating staff on its importance, emergency departments can significantly improve their financial health and operational effectiveness.

For more detailed information, including specific codes and their values, visit our blog or contact us directly. Keep coding and keep improving patient care!