Interventional procedures: physician involvement enhances clinical coding

Editor – The study by Hogarth et al (Clin Med April 2012 pp189) demonstrates marked improvement in coding and financial outcomes by better collaboration between clinicians and coders in the setting of electrophysiology and device procedures.¹ This is also generalisable to other interventional procedures, particularly as they tend to attract higher tariff and are typically performed in high volume as they generally require expertise in particular centres with sufficient patient flow, and hence the potential for financial disparity if these are miscoded is much higher. The principal requirement for success here is for better collaboration between clinicians and coders, although this can be achieved in different ways.

Indeed there is an unmet need for this, as the Audit Commission has noted that coding inaccuracies seem to be particularly prevalent in interventional specialties with significant national variation between 0.3% and 52% across acute trusts in England.² In the field of interventional pulmonology, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is performed in high volume in a number of centres. EBUS-TBNA attracts a far higher specific tariff than conventional fibreoptic bronchoscopy: nearly seven times more (£3404 (E63.2 + T87.4) versus £504 respectively).³

We (as well as the Audit Commission) have also previously demonstrated significant inaccuracies in coding in the field of interventional pulmonology, with >15% coding inaccuracy in a single centre for EBUS-TBNA and >68% inaccuracy for local anaesthetic thoracoscopy, with estimated financial discrepancies of at least £65,000 for one procedure in one centre annually.^4,5 We have managed to prevent all EBUS-TBNA coding errors by electronically notifying all procedures anonymously to a key member of the coding team after each procedure session, verified by independent cross-checking of the tariff applied and a monthly checklist from the coding team.⁶ This has now resulted in estimated savings of £78,000 for the last 165 EBUS-TBNA procedures (projected from the original error rate and cost saving).

In summary, small changes in collaborative behaviour between clinicians and coders in interventional specialties have the potential to make large cost savings even for one procedure alone, and can reduce financial disparity and are worthy of consideration. We therefore endorse the intervention by Hogarth et al and suggest this may be of particular relevance to other interventional specialties.