Comparing coding between interventional radiologists and hospital coding departments

J Cox¹, N Koutroumanos¹

¹Department of Radiology, University Hospital North Durham, Durham, UK

Purpose: The purpose of this audit was to assess whether there was a difference in the health care resource groups coding and subsequent reimbursement of interventional radiology cases, depending on whether the coding was carried out by a clinician or an administrator in the coding department

Methodology: A retrospective analysis was undertaken of 137 consecutive patients who had therapeutic endovascular procedures in our Trust from 2005–2007. Six patients were excluded due to lack of data. The audit was carried out at a single center. A single clinician, under the supervision of a consultant interventional radiologist, proceeded to code the procedure after referring to the patient’s radiology report and notes.

Findings: The error rate by part of the coding department in terms of assessing nonelective versus elective procedures was 7%. This had lead to a £2,352 excess charge on the part of the coding department. Additionally, there were errors in a further 19 procedures (15%), in which vascular stents had been inserted during the procedure but had not been coded for. The stent usage had not been recognised by the coding administrators in their evaluation, and this equipment-based undercoding resulted in underpayment by the patient’s primary care trust of £11,153.

Originality/value: This is the first published audit of coding in interventional radiology in the UK. Coding in complex subspecialties like vascular interventional radiology requires more clinical input and engagement to ensure the case complexity is accurately reflected in the codes assigned and in the subsequent reimbursement.

Keywords: coding, interventional radiology, payment by results (PBR)