Audit of clinical coding of major head and neck operations

Ann R Coll Surg Engl. 2009 Apr;91(3):245-8. doi: 10.1308/003588409X391884. Epub 2009 Feb 13.


Introduction: Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration.

Patients and methods: The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered.

Results: A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to pound15,300 loss of payment.

Conclusions: These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.

MeSH terms

  • Fees and Charges
  • Forms and Records Control / economics
  • Forms and Records Control / statistics & numerical data*
  • Head / surgery*
  • Humans
  • Medical Audit*
  • Neck / surgery*
  • Retrospective Studies
  • State Medicine / economics
  • Surgical Procedures, Operative / classification*
  • Surgical Procedures, Operative / economics
  • United Kingdom