News / Boost for accuracy but coding errors remain

The accuracy of clinical coding has improved since 2007, with the coding error rate falling from 16% to 11%, according to the Audit Commission’s latest payment by results (PBR) data assurance programme report. However, wide variation between trusts remained and errors continued to affect payments.

Since 2007 it has carried out random sample audits in four specialties – general medicine, trauma and orthopaedics, cardiology, and paediatrics – at all trusts. The commission has spotted £9m of errors in payments for £200m-worth of inpatient work over the past three years.

Its report, Improving data quality in the NHS, estimated that of the £21bn spent on the four specialties over the past three years, £1bn (5%) was paid incorrectly.

Andy McKeon, the commission’s managing director, health, said there was no systematic gaming in the system. The financial impact of the coding errors was minimal – in the first two years the average net over- or under-charge was almost zero, but in 2009/10 primary care trusts were slightly undercharged (though this was still less than 1%). In more than a quarter of trusts, PCTs would have paid 2%-8% more if coding had been correct.

The commission audited outpatient payment data for the first time in 2009/10. The average error rate was 5.2%, with a range of 0%-45%.

The average healthcare resource group (HRG) error rate increased slightly in 2009/10, but the commission believed this was due to the switch from version 3.5 to the more detailed HRG4 for payments that year. HRG4 is more sensitive to coding errors.

Mr McKeon said it was reassuring that clinical coding was improving, but the variations from trust to trust was a concern. The PBR data assurance framework programme for 2010/11 would continue despite the recent announcement that the commission would be abolished.

‘There are clear ways in which trusts can improve and we’ll be focusing our 2010/11 clinical coding audits on the trusts that most need help. We will also be auditing the costing submissions of acute trusts that underpin the tariff and which are also used in local price negotiations,’ he added.

Trusts should perform regular internal audits on clinical coding and outpatient data, and ensure medical records were of good quality, the commission said.