Presumptive coding. A preliminary study of the aggregation of input diagnoses to determine their relevance to clinical governance and urological resourcing.
OBJECTIVE
To determine the validity of a system for coding the reason for urological referral from primary care, using ICD10, and thus enable benchmarking of urological outpatient activity.


METHODS
Four studies were conducted: (i) A pilot study to aggregate information into a few input diagnosis codes (925 patients); (ii) Validation of the aggregated codes using input diagnoses from a second centre (928 patients); (iii) A prospective study by three urologists to determine the system's generic utility (918 patients); (iv) A study to aggregate the presumptive codes for 2771 patients to gain an insight into the case-mix of patients referred to a general urological service via the outpatient department.


RESULTS
The aggregation of input diagnoses from general practice referrals into 36 'presumptive codes' was possible and could be validated. Prospective coding, for 96% of eligible patients, was possible with < 1% of referral diagnoses not being codable. Further aggregation of the data for 2771 patients showed that 31% were referred with urological malignancy whilst 69% had symptoms suggesting benign urological disease.


CONCLUSIONS
This preliminary study of presumptive coding suggests that it is a feasible and valid method of recording the input diagnoses for patients presented to a urological service. The information it provides has relevance for the structuring, benchmarking, resourcing and manpower requirements of that service, essential components for clinical governance. It also has relevance to the prospective collection of patient data for research and audit.
Department of Urology, Manchester Royal Infirmary, Manchester, UK. stevepayne.urol@btinternet.com
S R
SR
Payne
R D
RD
Napier-Hemy
T
T
Ganesan
W H
WH
Turner
D004739:England; D005194:Family Practice; D005568:Forms and Records Control; D006801:Humans; D008499:Medical Records / Q000592:standards*; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D014570:Urologic Diseases / Q000628:therapy*