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Coding errors down but will rise again

NHS trusts have made fewer coding errors under the PbR system – but a rise is expected this year because of HRG4.

By Susan McNulty

NHS trusts have made fewer coding errors under the PbR system – but a rise is expected this year because of HRG4.

The Audit Commission carried out an audit of medical records for the second year running and found more than 12% of the clinical codes for diagnoses and procedures were wrong for 2008/9 compared with 16.5% in 2007/8.

But the introduction of HRG4, with its 2,500 codes compared with 650 under the old HRG 3.5, means errors are expected to increase again in the forthcoming year.

The Audit Commission's managing director, Andy McKeon, said: ‘There is a clear picture of improvement in the way trusts are coding data for payment under PbR but problems remain and there is significant variation in trust performance ranging from virtually zero errors to 40%.

‘Crucially the payments system is now more sophisticated and more sensitive to data quality accuracy which means we are likely to see an increase in error rates in 2009/10.'

Some medical records picked to be audited for the report – called the PbR Data Assurance Framework – were deemed too unsafe to be used, raising issues about the poor quality of some medical records.

About 80% of PbR audit reports recorded problems relating to the quality of records, prompting the Audit Commission to publish alongside its framework a report from the Royal College of Physicians, which makes a number of recommendations to improve the recording of medical information.

Professor Iain Carpenter, associate director, records standards, at the Royal College of Physicians, said: ‘Implementing the Academy of Medical Royal Colleges' Record Keeping Standards can improve medical records and the accurate retrieval of important clinical data.

‘This report also shows that using the standards would make clinical coding more efficient and accurate, reducing financial errors in the reimbursement of hospital activity – particularly in 2009/10 with the introduction of HRG4, which is more sensitive to coding accuracy and data quality.'

NAPC chair Dr Johnny Marshall said it was vital to have a clear picture of current activity when redesigning services.

He said: ‘Without accurate coding information the danger is we might make wrong (commissioning) decisions.

‘Coding is a real issue and causes much angst between provider and commissioner.'

Dr Marshall also welcomed calls for quality control of medical records.

He said: ‘The issue of managing patients and greater integration means we need to ensure really good communication between primary and secondary care.'

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