title: Cracking the code: the accuracy of coding shoulder procedures and the repercussions.
abstract: BACKGROUND
  Coding of patients' diagnosis and surgical procedures is subject to error levels of up to 40% with consequences on distribution of resources and financial recompense. Our aim was to explore and address reasons behind coding errors of shoulder diagnosis and surgical procedures and to evaluate a potential solution.
  
  
  METHODS
  A retrospective review of 100 patients who had undergone surgery was carried out. Coding errors were identified and the reasons explored. A coding proforma was designed to address these errors and was prospectively evaluated for 100 patients. The financial implications were also considered.
  
  
  RESULTS
  Retrospective analysis revealed the correct primary diagnosis was assigned in 54 patients (54%) had an entirely correct diagnosis, and only 7 (7%) patients had a correct procedure code assigned. Coders identified indistinct clinical notes and poor clarity of procedure codes as reasons for errors. The proforma was significantly more likely to assign the correct diagnosis (odds ratio 18.2, p < 0.0001) and the correct procedure code (odds ratio 310.0, p < 0.0001). Using the proforma resulted in a £28,562 increase in revenue for the 100 patients evaluated relative to the income generated from the coding department.
  
  
  CONCLUSIONS
  High error levels for coding are due to misinterpretation of notes and ambiguity of procedure codes. This can be addressed by allowing surgeons to assign the diagnosis and procedure using a simplified list that is passed directly to coding.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK. nickclement@doctors.org.uk
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.forename: I R
authors.initials: IR
authors.lastname: Murray
authors.forename: Y X
authors.initials: YX
authors.lastname: Nie
authors.forename: J M
authors.initials: JM
authors.lastname: McBirnie
mesh_terms: D001182:Arthroscopy / Q000145:classification*; D059019:Clinical Coding; D003951:Diagnostic Errors; D006801:Humans; D038801:International Classification of Diseases; D007592:Joint Diseases / Q000145:classification* / Q000601:surgery; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*
keywords: Coding; cost; payment by results; shoulder; tariff