Epidemiology and benefit to patients from accurate coding

Epidemiology and benefit to patients
from accurate coding
Heather Walker
CHKS Consultancy and Marketing Director
4th May 2012
Epidemiology is the study of how often diseases occur in different groups of
people and why. Epidemiological information is used to plan and evaluate
strategies to prevent illness and as a guide to the management of patients
in whom disease has already developed.
Epidemiological observations may also guide decisions about individuals,
but they relate primarily to groups of people. This fundamental difference in
the purpose of measurements implies different demands on the quality of
Another task of epidemiology is monitoring or surveillance of time trends to
show which diseases are increasing or decreasing in incidence and
which are changing in their distribution. This information is needed to
identify emerging problems and also to assess the effectiveness of
measures to control old problems.
The Coding Process – admitted patient care
Admission to
Discharge following
The Patient
Coded information
recorded on the hospital
Information abstracted from
case notes and translated
into coded format using the
ICD & OPCS classifications
Coding Requirements
Primary Diagnosis:
Main condition treated or investigated during the relevant episode of care, or
Where no definitive diagnosis can be made, the main symptom, abnormal findings
or problem
Secondary Diagnosis:
All related conditions which could affect treatment or length of stay
Primary Procedure:
The main procedure/intervention undertaken during that period of hospital care
Secondary Procedures:
Other procedures/interventions undertaken secondary to the primary procedure.
What do we mean by accurate coding and how
can this be achieved
That there is a
approach and
the correct
coding rules are
There is
appropriate audit
to improve
quality and
highlight training
Qualifications in Coding – For consistency and accuracy
The National Clinical Coding Qualification (UK) is the only nationally
recognised qualification for clinical coders working in the NHS.
Delivered in partnership with IHRIM
The NHS Classifications Service develops the examination paper to
current national clinical coding standards..
Candidates who pass both examination papers are awarded
Accredited Clinical Coder (ACC) status by IHRIM
Since they started 1519 coders have achieved ACC status
Some of these coders go on to become clinical coding auditor
and/or trainers
Consistent and correct – NHS Connecting for
Health Classifications Service
Advise - good
surrounding coding
collection and
investment in training
and accreditation
Appropriate Audit
Data validated and audited is most likely to be
recognised as a true reflection of hospital activity so
establishing regular clinical coding internal audits at your
trust ensures a robust data quality cycle.
Clinical coding audit is also an integral part of the
Information Governance Requirement 505
Audit Commission Data Assurance Framework
underpinning PBR audits
Publications on improving coding and data quality
The Royal College of Physicians (HIU) Information
Laboratory iLab– Project Evaluation Report – September
Availability of information for appraisal, interaction
with clinical coders and accuracy of information
‘Top ten tips for coding – a guide for clinical staff’ – RCP
Health Informatics Unit 2007
‘Improving clinical coding and clinical records together’
RCP with the Audit Commission – August 2009
Clinical coding from full medical record
Consistent approach to medical record
What happens to the coded data
Good quality information feeds decision making
Health Service
coding and
procedure data
Using coded indicators to drive change
and benefit patient care
Mortality and Morbidity Reviews
Reviewing all deaths and the coding associated with these cases
Reviewing complications and misadventures to highlight which
procedures have higher than expected rates
Patient safety and quality boards
Improving Stroke Mortality
Do hospital records match those reported for the
National Sentinel Stroke Audit
30 day mortality has fallen from 24% to 17% in the 2004
– 2010 period
Change through Use of Good Quality Coded Data
Introduction of a dedicated syncope and falls facility to
reduce impact on emergency admissions.
Syncope and collapse identified from coding using ICD10 is 6th most common
reason for elderly admissions to hospital. A dedicated facility reduced required
inpatient beds by 18 in Newcastle compared with other teaching hospitals, also
reducing cost and consultant episodes. Age and aging 2002;31:272-275
Disposable tonsillectomy kits (RCS May2005)
Identified at trusts due to increase in the number of cases with a diagnosis
code of haemorrhage or haematoma complicating a procedure.
Using coded data for revalidation and appraisal
Supporting Information for appraisal and revalidation –
Vascular surgery complication rates
following surgery
Information Flows
Benefits to patients through accurate coding
Not always obvious that coding can benefit patients
Benefits may not be immediate
Accurate coding can lead to change in practice and
services which will benefit all future patients
Accurate and consistent coding allows for comparisons
which can change health service delivery or provision
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